1851335814 NPI number — NICKY HARTDEGEN CRNA

Table of content: NICKY HARTDEGEN CRNA (NPI 1851335814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851335814 NPI number — NICKY HARTDEGEN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTDEGEN
Provider First Name:
NICKY
Provider Middle Name:
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:
1851335814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LULING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78648-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-875-6786
Provider Business Mailing Address Fax Number:
830-875-6790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-632-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

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:  457349 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 137810112 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3657500000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160955401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C85R . This is a "BCBS GRP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 82882U . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 457349 . This is a "CRNA LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com