Provider Demographics
NPI:1144347519
Name:DUDERSTADT, KAREN G (NP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:G
Last Name:DUDERSTADT
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 6M
Mailing Address - Street 2:SFGH CHILDREN'S CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-5908
Mailing Address - Fax:415-753-2161
Practice Address - Street 1:1001 POTRERO AVE # 6M
Practice Address - Street 2:SFGH CHILDREN'S CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5908
Practice Address - Fax:415-753-2161
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN229710163WP2201X
CANPF3424363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
030841OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
030841OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER