Organization
BLUEBONNET ANESTHESIA SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKY HARTDEGEN CRNA (PRESIDENT OWNER)
(830) 237-2323
Entity
Organization
Contact information
Practice address
600 N UNION AVE, NEW BRAUNFELS, TX 78130-4194
(830) 237-2323
(830) 875-2658
Mailing address
PO BOX 1108, LULING, TX 78648-1108
(830) 237-2323
(830) 875-2658
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
457349
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C85R
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/13/2006
Last updated
08/22/2020
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