Provider Demographics
NPI:1952698060
Name:FONGHEISER, KAREN (CRNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FONGHEISER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1233
Mailing Address - Country:US
Mailing Address - Phone:410-350-3601
Mailing Address - Fax:410-354-2648
Practice Address - Street 1:2311 WEATHERVANE RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2656
Practice Address - Country:US
Practice Address - Phone:410-529-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143077363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health