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General NPI Number Information
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NPI Number | 1093591786
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Entity Type | Individual
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Provider Name | HYDER I MIRZA APRN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1100 E NORRIS DR
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City | OTTAWA
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State | IL
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Zip | 61350-1604
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Country | US
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Telephone | 815-433-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E NORRIS DR
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City | OTTAWA
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State | IL
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Zip | 61350-1604
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Country | US
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Telephone | 815-433-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 041.529930
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209032471
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License Number State | IL
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