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NPI Code Detail

MEDICARE: MARY F HARTMAN CRNA

MEDICARE: MARY F HARTMAN CRNA
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 Anesthetist209-001121IL

General Provider Information

NPI Number : 1558368282
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY F HARTMAN CRNA
Provider Business Mailing Address
First Line : 1465 SILVER LEAF AVE
Second Line :
City : MT ZION
State : IL
Zip : 62549-1780
Country : US
Telephone Number : 217-422-3350
Fax Number :
Provider Business Practice Location Address
First Line : 1800 E LAKE SHORE DR
Second Line :
City : DECATUR
State : IL
Zip : 62521-3810
Country : US
Telephone Number : 217-464-2729
Fax Number : 217-464-1693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 01/04/2024

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