Provider Demographics
NPI:1104995596
Name:ARNDT, KAREN LISA (ARNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LISA
Last Name:ARNDT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3704
Mailing Address - Country:US
Mailing Address - Phone:360-249-4111
Mailing Address - Fax:360-249-5220
Practice Address - Street 1:112 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3704
Practice Address - Country:US
Practice Address - Phone:360-249-4111
Practice Address - Fax:360-249-5220
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9612227Medicaid
R12823Medicare UPIN
WAGAB18340Medicare PIN