Provider Demographics
NPI:1740323070
Name:PERTL, KAREN (CRNA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:PERTL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 CASTLEPOINTE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8287
Mailing Address - Country:US
Mailing Address - Phone:330-284-3848
Mailing Address - Fax:
Practice Address - Street 1:1339 CASTLEPOINTE CIRCLE
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8287
Practice Address - Country:US
Practice Address - Phone:330-284-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.190028163W00000X
OH048040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000263065OtherANTHEM PROVIDER #
OH2284086Medicaid
OH8220394Medicare ID - Type Unspecified