Provider Demographics
NPI:1962517029
Name:WERNICKE, KAREN ANN (CS, APRN)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:WERNICKE
Suffix:
Gender:F
Credentials:CS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 INDEPENDENCE CIR
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6405
Mailing Address - Country:US
Mailing Address - Phone:757-473-8533
Mailing Address - Fax:757-456-0616
Practice Address - Street 1:700 INDEPENDENCE CIR
Practice Address - Street 2:SUITE 3D
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6405
Practice Address - Country:US
Practice Address - Phone:757-456-0616
Practice Address - Fax:757-456-0616
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000790364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180111OtherANTHEM
VA010176000Medicaid
O85448MOtherOPTIMA/ SENTARA
VA010176000Medicaid
O85448MOtherOPTIMA/ SENTARA