Provider Demographics
NPI:1619087962
Name:HARDAWAY, RUSSELL G (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:G
Last Name:HARDAWAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7717 LOCKHEED DR STE E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2437
Mailing Address - Country:US
Mailing Address - Phone:915-577-0111
Mailing Address - Fax:915-533-2568
Practice Address - Street 1:7717 LOCKHEED DR STE E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2437
Practice Address - Country:US
Practice Address - Phone:915-577-0111
Practice Address - Fax:915-533-2568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21851367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered