Basic Information
Provider Information
NPI: 1063512929
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMLETT-KLEINHENZ
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APN-CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2650 RIDGE AVE
Address2: EVANSTON HOSPITAL
City: EVANSTON
State: IL
PostalCode: 602011718
CountryCode: US
TelephoneNumber: 8475701206
FaxNumber: 8475701248
Practice Location
Address1: 2650 RIDGE AVE
Address2: ANESTHESIOLOGY ROOM 3905
City: EVANSTON
State: IL
PostalCode: 602011718
CountryCode: US
TelephoneNumber: 8475702921
FaxNumber: 8475702921
Other Information
ProviderEnumerationDate: 09/22/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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