Provider Demographics
NPI:1851354435
Name:HOGENDOBLER, CHRISTINE LIANA (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LIANA
Last Name:HOGENDOBLER
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 1:30 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-9606
Mailing Address - Fax:573-334-9608
Practice Address - Street 1:30 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-9606
Practice Address - Fax:573-334-9608
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128771367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO166636OtherBCBS
MO430080191OtherRAILROAD MEDICARE
MOA141OtherCHAMPUS TRICARE
MO915274013Medicaid
MO110375OtherHEALTH LINK
MO166636OtherBCBS