Provider Demographics
NPI:1528095197
Name:MALDONADO, KARLA L (CRNA)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:L
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LAKESHORE CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4514
Mailing Address - Country:US
Mailing Address - Phone:586-481-0983
Mailing Address - Fax:
Practice Address - Street 1:575 LAKESHORE CIR APT 204
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4514
Practice Address - Country:US
Practice Address - Phone:586-481-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704193067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI474024510Medicaid
MIF36441156Medicare PIN