Healthcare Provider Details

I. General information

NPI: 1316031180
Provider Name (Legal Business Name): KAREN J. HARBAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CIVIC CIRCLE BLVD
MARION IL
62959-5259
US

IV. Provider business mailing address

3003 CIVIC CIRCLE BLVD
MARION IL
62959-5259
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-1112
  • Fax: 618-993-1113
Mailing address:
  • Phone: 618-993-1112
  • Fax: 618-993-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3703A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: