Provider Demographics
NPI:1982049540
Name:SREBACIC, KAREN M
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:SREBACIC
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:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:CO
Mailing Address - Zip Code:81433-0683
Mailing Address - Country:US
Mailing Address - Phone:970-769-2259
Mailing Address - Fax:
Practice Address - Street 1:1043 MINERAL STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:CO
Practice Address - Zip Code:81433-0683
Practice Address - Country:US
Practice Address - Phone:970-769-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55803172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver