Healthcare Provider Details

I. General information

NPI: 1821199159
Provider Name (Legal Business Name): MARY KATHLEEN HIDALGO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 FAIR RIDGE DR SUITE 320
FAIRFAX VA
22033-2907
US

IV. Provider business mailing address

500 HOSPITAL DR
WARRENTON VA
20186-3027
US

V. Phone/Fax

Practice location:
  • Phone: 703-295-9360
  • Fax: 703-295-9369
Mailing address:
  • Phone: 540-349-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-101930
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167953
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number178681
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: