Healthcare Provider Details

I. General information

NPI: 1114459724
Provider Name (Legal Business Name): COURTNEY ANN HARTBERG CRNA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WESTOWN PKWY STE 210
WEST DES MOINES IA
50266-8297
US

IV. Provider business mailing address

1750 N JONES BLVD UNIT 1
NORTH LIBERTY IA
52317-8825
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-9222
  • Fax: 515-221-0575
Mailing address:
  • Phone: 515-979-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD156059
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: