Healthcare Provider Details

I. General information

NPI: 1447410147
Provider Name (Legal Business Name): ROBIN K HIRTH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 OLD DES PERES RD
DES PERES MO
63131-1865
US

IV. Provider business mailing address

13523 BARRETT PARKWAY DR STE 210
BALLWIN MO
63021-3802
US

V. Phone/Fax

Practice location:
  • Phone: 314-775-2264
  • Fax:
Mailing address:
  • Phone: 314-775-2816
  • Fax: 314-775-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2005007450
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: