Healthcare Provider Details

I. General information

NPI: 1497811327
Provider Name (Legal Business Name): JAMES HARDIE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 HIGHWAY 110 W
HEBER SPRINGS AR
72543-3442
US

IV. Provider business mailing address

PO BOX 1106
HEBER SPRINGS AR
72543-1106
US

V. Phone/Fax

Practice location:
  • Phone: 501-206-3263
  • Fax:
Mailing address:
  • Phone: 501-206-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00170 CRNA
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: