Provider Demographics
NPI:1386951044
Name:HARWAY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HARWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 WRIGHT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4041
Mailing Address - Country:US
Mailing Address - Phone:916-482-4856
Mailing Address - Fax:
Practice Address - Street 1:1750 WRIGHT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4041
Practice Address - Country:US
Practice Address - Phone:916-482-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10114363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548447378Medicaid
CA1649457474Medicaid
CA1730237116Medicaid
CA1275710006Medicaid