Provider Demographics
NPI:1225756612
Name:HERTZOG, KAREN (PAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HERTZOG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 8TH AVE SW STE A2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2962
Mailing Address - Country:US
Mailing Address - Phone:206-246-1012
Mailing Address - Fax:206-242-4437
Practice Address - Street 1:16110 8TH AVE SW STE A2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-246-1012
Practice Address - Fax:206-242-4437
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61599872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant