Basic Information
| Provider Information | |||||||||
| NPI: | 1659621100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACK | ||||||||
| FirstName: | JAMI | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7887 N LA CHOLLA BLVD | ||||||||
| Address2: | APT 3175 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857414313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053901101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 S 6TH AVE # 7-11A | ||||||||
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| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206291814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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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 | 163W00000X | R031699 | SD | N | Nursing Service Providers | Registered Nurse | 367500000X | CRNA0902 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.