Provider Demographics
NPI:1750557633
Name:HACKMANN, KAREN CAVENDER (GCNS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:CAVENDER
Last Name:HACKMANN
Suffix:
Gender:F
Credentials:GCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:MC11 (DCO92.10)
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-0001
Mailing Address - Country:US
Mailing Address - Phone:573-884-9924
Mailing Address - Fax:573-884-5735
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:MC11 (DCO92.10)
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-9924
Practice Address - Fax:573-884-5735
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089691364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology