Individual
MARY G HARTZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CRNA
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
4100 DUVAL RD, BLDG 3, AUSTIN, TX 78759-4275
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
697733
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP116926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89461U
BCBSTX
TX
Enumeration date
07/14/2008
Last updated
11/16/2022
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