Individual
NICKY HARTDEGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
101 E RIDGE RD, MCALLEN, TX 78503-1847
(956) 632-6000
Mailing address
PO BOX 1108, LULING, TX 78648-1108
(830) 875-6786
(830) 875-6790
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
BCBS GRP NUMBER
TX
05
—
137810112
—
TX
05
—
160955401
—
TX
01
—
3657500000X
TAXONOMY CODE
TX
01
—
457349
CRNA LICENSE
TX
01
—
82882U
BCBS
TN
Enumeration date
06/16/2006
Last updated
06/17/2015
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