Provider Demographics
NPI:1952419939
Name:SLAKEY, KAREN P (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:P
Last Name:SLAKEY
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 1:7872 DEMONTREVILLE TRL N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-9537
Mailing Address - Country:US
Mailing Address - Phone:925-890-6239
Mailing Address - Fax:
Practice Address - Street 1:7872 DEMONTREVILLE TRL N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9537
Practice Address - Country:US
Practice Address - Phone:925-890-6239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1729377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ13319Medicare UPIN
CAZZZ28958ZMedicare PIN