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NPI Code Detail

MEDICARE: MARY KATHERINE HARTZOG RN

MEDICARE: MARY KATHERINE HARTZOG RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist32033SC
2163WC0200XCritical Care Medicine Registered Nurse257085SC

General Provider Information

NPI Number : 1275370942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHERINE HARTZOG RN
Provider Business Mailing Address
First Line : 856 BIBURY CT
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-9120
Country : US
Telephone Number : 770-861-8961
Fax Number :
Provider Business Practice Location Address
First Line : 2095 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5733
Country : US
Telephone Number : 843-792-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2024
Last Update Date : 06/04/2026

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