Provider Demographics
NPI:1477090322
Name:HART, JAMIE (CRNA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HART
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:SEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1782 S. MORELAND RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-6202
Mailing Address - Country:US
Mailing Address - Phone:618-580-7788
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1099
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017006967367500000X
IL209015705367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered