Basic Information
| Provider Information | |||||||||
| NPI: | 1134744162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTGRAVES | ||||||||
| FirstName: | ZANE | ||||||||
| MiddleName: | NOEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 CHRISTY DR STE B | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651012853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736363483 | ||||||||
| FaxNumber: | 5736363386 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 MISSION DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651099508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736363483 | ||||||||
| FaxNumber: | 5736363386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2020016691 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.