Healthcare Provider Details

I. General information

NPI: 1356375869
Provider Name (Legal Business Name): LEESA R HARTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR SW ANESTHESIA DEPT
HUNTSVILLE AL
35801-6455
US

IV. Provider business mailing address

PO BOX 5538
FRESNO CA
93755-5538
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4187
  • Fax: 256-880-4797
Mailing address:
  • Phone: 559-436-1000
  • Fax: 559-354-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-083549
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: