Provider Demographics
NPI:1538154372
Name:BORDEWYK, KAREN M (CRNA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BORDEWYK
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 1:4500 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8148
Mailing Address - Country:US
Mailing Address - Phone:605-977-7000
Mailing Address - Fax:605-977-7001
Practice Address - Street 1:4500 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-7000
Practice Address - Fax:605-977-7001
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR018040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0551267Medicaid
SD0008160OtherWELLMARK
SD5751750Medicaid
SDS8160Medicare PIN