1356375869 NPI number — LEESA R HARTZ CRNA

Table of content: LEESA R HARTZ CRNA (NPI 1356375869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356375869 NPI number — LEESA R HARTZ CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTZ
Provider First Name:
LEESA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356375869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5538
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93755-5538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-436-1000
Provider Business Mailing Address Fax Number:
559-354-4235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DR SW
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-6455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-880-4187
Provider Business Practice Location Address Fax Number:
256-880-4797
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  1-083549 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-33143 . This is a "BLUE CROSS HOSPITAL BASED" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 075106 . This is a "CCNA #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051533143 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1-083549 . This is a "RN & CRNA LICENSE #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".