Healthcare Provider Details

I. General information

NPI: 1174625149
Provider Name (Legal Business Name): KAREN S HARTZEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KAREN S. BAUM

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SUNSET DR
VANDALIA IL
62471-3228
US

IV. Provider business mailing address

1510 SUNSET DRIVE
VANDALIA IL
62471-0000
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-3144
  • Fax: 618-283-3194
Mailing address:
  • Phone: 618-283-3144
  • Fax: 618-283-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041164815
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209002179
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209002179
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: