Provider Demographics
NPI:1306899257
Name:GRUNEWALD, KAREN B (APRN)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:B
Last Name:GRUNEWALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HAWKES WAY
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4425
Mailing Address - Country:US
Mailing Address - Phone:802-578-4613
Mailing Address - Fax:
Practice Address - Street 1:210 CORNELIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2318
Practice Address - Country:US
Practice Address - Phone:518-562-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0029403163W00000X
NYF303176363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010808Medicaid
VTQ00309Medicare UPIN
VT1010808Medicaid