Basic Information
Provider Information
NPI: 1033558325
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUDAC
FirstName: KARINA
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: LPN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 170 SHAFFER RD
Address2:  
City: SEWICKLEY
State: PA
PostalCode: 151439684
CountryCode: US
TelephoneNumber: 7242668609
FaxNumber:  
Practice Location
Address1: 659 3RD ST
Address2:  
City: BEAVER
State: PA
PostalCode: 150092115
CountryCode: US
TelephoneNumber: 7247751118
FaxNumber: 7247752375
Other Information
ProviderEnumerationDate: 06/19/2013
LastUpdateDate: 06/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000XPN257405LPAY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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