Provider Demographics
NPI:1609136746
Name:HARDIMAN, KYLE (CRNA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HARDIMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1114
Mailing Address - Country:US
Mailing Address - Phone:618-544-3131
Mailing Address - Fax:618-546-2630
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1114
Practice Address - Country:US
Practice Address - Phone:618-544-3131
Practice Address - Fax:618-546-2630
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-359377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-359377OtherLICENSE NUMBER