Organization
UNITED STATES NAVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY GEORGE NITZ CRNA (NURSE ANESTHETIST)
(314) 518-9118
Entity
Organization
Contact information
Practice address
704 GUENEVERE DR, BALLWIN, MO 63011-3525
(636) 386-2729
(636) 527-8189
Mailing address
704 GUENEVERE DR, BALLWIN, MO 63011-3525
(636) 386-2729
(636) 527-8189
Taxonomy
Speciality
Code
Description
License number
State
2865X1600X
Operational (Transportable) Military General Acute Care Hospital
Primary
064569
MO
Other
Enumeration date
12/09/2006
Last updated
08/22/2020
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