Provider Demographics
NPI:1912911793
Name:PETRUNEY, KAREN M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:PETRUNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 TWENTY MILE STREAM RD
Mailing Address - Street 2:
Mailing Address - City:PROCTORSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05153-9716
Mailing Address - Country:US
Mailing Address - Phone:203-819-2121
Mailing Address - Fax:
Practice Address - Street 1:38 ROUTE 11
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:VT
Practice Address - Zip Code:05148-9555
Practice Address - Country:US
Practice Address - Phone:802-824-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3V5927OtherHEALTHNET
CT22-77593OtherAMERICHOICE
CT004254314Medicaid
CT7681206OtherAETNA
CT180092OtherWELLCARE
CT400001905CT01OtherANTHEM BLUE CROSS
CTP4231031OtherOXFORD
CT1143111OtherUSA
CT740168OtherCONNECTICARE
CTPENDINGOtherRR MEDICARE
CT740168OtherCONNECTICARE
CTP4231031OtherOXFORD
CT7681206OtherAETNA
CT22-77593OtherAMERICHOICE