Basic Information
| Provider Information | |||||||||
| NPI: | 1275693285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROTE-HINTZ | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 SHERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600442203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476152200 | ||||||||
| FaxNumber: | 8887358732 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710522603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188724160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP03009 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN086632 | LA | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1694401 | 05 | LA | MEDICAID |