Provider Demographics
NPI:1902999105
Name:DELONG, KAREN SMITH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SMITH
Last Name:DELONG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:DELONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:2608 KEISER BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3333
Mailing Address - Country:US
Mailing Address - Phone:610-685-5864
Mailing Address - Fax:610-929-9395
Practice Address - Street 1:2608 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3333
Practice Address - Country:US
Practice Address - Phone:610-685-5864
Practice Address - Fax:610-929-9395
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104238Medicare PIN