Basic Information
| Provider Information | |||||||||
| NPI: | 1861848509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLBA | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 SUMMIT AVENUE | ||||||||
| Address2: | MSO PHYSICIAN BILLING | ||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402837597 | ||||||||
| FaxNumber: | 7402837190 | ||||||||
| Practice Location | |||||||||
| Address1: | 15655 STATE ROUTE 170 STE B | ||||||||
| Address2: | |||||||||
| City: | EAST LIVERPOOL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439209672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309320909 | ||||||||
| FaxNumber: | 3309320769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 221379 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0296034 | 05 | OH | MEDICAID |