Provider Demographics
NPI:1023286887
Name:THOMAE, KAREN AMES (PA)
Entity type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:AMES
Last Name:THOMAE
Suffix:
Gender:F
Credentials:PA
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 122
Mailing Address - Street 2:
Mailing Address - City:PORT CRANE
Mailing Address - State:NY
Mailing Address - Zip Code:13833
Mailing Address - Country:US
Mailing Address - Phone:607-725-5461
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQUARE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant