MEDICARE: KAREN LYNN STAUB CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN043565	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396704144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNN STAUB CRNA

Provider Business Mailing Address
First Line	:	DEPT 1029 PO BOX 740209
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0209
Country	:	US
Telephone Number	:	941-360-1566
Fax Number	:	941-358-9818

Provider Business Practice Location Address
First Line	:	5671 PEACHTREE-DUNWOODY ROAD
Second Line	:	SUITE 680
City	:	ATLANTA
State	:	GA
Zip	:	30342-5014
Country	:	US
Telephone Number	:	404-705-6985
Fax Number	:	404-851-9950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/15/2010

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