Provider Demographics
NPI:1104857309
Name:HART, CHRISTINE L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-1475
Mailing Address - Country:US
Mailing Address - Phone:214-373-9092
Mailing Address - Fax:214-373-9250
Practice Address - Street 1:11910 GREENVILLE AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-373-9092
Practice Address - Fax:214-373-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8552UGOtherBCBSTX
TX184115702Medicaid
TXP01013174OtherRAILROAD
TX184115701Medicaid
TX184115703Medicaid
TX184115704Medicaid
TXTXB136685Medicare PIN
TX184115703Medicaid
TXTXB146346Medicare PIN
TX184115704Medicaid