Provider Demographics
NPI:1124087705
Name:STREAT, KAREN GRAY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GRAY
Last Name:STREAT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KEY HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5116
Mailing Address - Country:US
Mailing Address - Phone:410-230-7800
Mailing Address - Fax:410-230-7801
Practice Address - Street 1:1420 KEY HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5116
Practice Address - Country:US
Practice Address - Phone:410-230-7800
Practice Address - Fax:410-230-7801
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR106862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD271104400Medicaid
MD607409OtherBC/BS
MD607409OtherBC/BS
MD271104400Medicaid