Basic Information
| Provider Information | |||||||||
| NPI: | 1558368282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTMAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 SILVER LEAF AVE | ||||||||
| Address2: | |||||||||
| City: | MT ZION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625491780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174223350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 E LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625213810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174642729 | ||||||||
| FaxNumber: | 2174641693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209-001121 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.