DIANE L HARTZOG (NPI# 1871538744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871538744 |
| Entity Type | Individual |
| Full Name | DIANE L HARTZOG |
| Credential | CRNA |
| Practice Address |
125 Hospital Drive Watertown WI 53098 |
| Mailing Address |
4555 West Schroeder Drive Suite 170 Milwaukee WI 53223 |
| Practice Telephone | 9202624450 |
| Mailing Telephone | 4143653210 |
| Mailing Fax Number | 4143653225 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2008-03-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | 78920030 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43379900 | 05 |
| Street Address |
125 HOSPITAL DRIVE |
| City | WATERTOWN |
| State | WI |
| Zip Code | 53098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528560018 | Watertown Medical Center LLC | Psychiatric Unit | 125 Hospital Drive, Watertown, WI 53098 | 2018-03-01 |
| 1831420587 | Watertown Heart Institute Sc | Specialist | 125 Hospital Drive, Watertown, WI 53098-3303 | 2010-01-20 |
| 1629299698 | Joan A Brown-dougherty | Occupational Therapist | 125 Hospital Drive, Watertown, WI 53098 | 2007-05-01 |
| 1174611529 | Pierce James Meier | Radiology | 125 Hospital Drive, Watertown Memorial Hospital, Watertown, WI 53094 | 2006-10-11 |
| 1942397096 | David G Parkins | Anesthesiology | 125 Hospital Drive, Watertown, WI 53098-3303 | 2006-10-09 |
| 1265444103 | Peter C Silvers | Physician Assistant | 125 Hospital Drive, Watertown, WI 53098-3384 | 2006-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528558749 | Watertown Physician Practices LLC | Eyewear Supplier (Equipment, not the service) | 123 Hospital Dr Ste 2005, Watertown, WI 53098 | 2018-05-14 |
| 1851822076 | Fort Health Care Inc | Otolaryngology | 123 Hospital Dr Suite 106a, Watertown, WI 53098 | 2017-03-21 |
| 1598045692 | Bonnie Kay Peot | Licensed Practical Nurse | 1420 Wedgewood Drive, Watertown, WI 53098 | 2011-08-19 |
| 1275790404 | Kathy R. Adkins | Physical Therapy Assistant | 1020 Hill Street, Watertown, WI 53098 | 2008-05-16 |
| 1336361294 | Patrice Walter | Occupational Therapist | 125 Hospital Dr., Watertown, WI 53098 | 2007-05-02 |
| 1720161284 | Carolyn T Schneider-donley | Optometrist | 622 N. Church Street, Watertown, WI 53098 | 2006-10-20 |
| 1730156431 | Mohamed H Yafai | Internal Medicine | 123 Hospital Drive, Suite 2009, Watertown, WI 53098 | 2006-03-02 |
| 1093711236 | Dana M. Fields | Physician Assistant | 134 Hospital Drive, Watertown, WI 53098 | 2005-06-22 |
| 1437544863 | Zachary Richardson | Internal Medicine | 125 Hospital Dr, Watertown, WI 53098 | 2015-04-02 |
| 1942699632 | Morgan Lange Hennes | Specialist/Technologist | 125 Hospital Dr, Watertown, WI 53098 | 2015-01-18 |
| Find all providers in zip 53098 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962054668 | Brandon Camel | Anesthesiologist Assistant | 619 N Segoe Rd, Madison, WI 53705-3112 | 2019-07-12 |
| 1407329428 | Kayla M Hickmann | Anesthesiologist Assistant | 5311 S Ridge Way Apt 204, Middleton, WI 53562-1244 | 2019-01-03 |
| 1730637976 | William Brett Organ | Anesthesiologist Assistant | 2915 E Wanda Ave, Cudahy, WI 53110-2536 | 2016-09-16 |
| 1134675358 | Kojo Bempong | Anesthesiologist Assistant | Ahcmg Anesthesiology, 4025 North 92nd Street, Wauwatosa, WI 53022 | 2016-08-28 |
| 1669857660 | Cayla Joanne Dittmer | Anesthesiologist Assistant | 818 N Star Dr Apt 119, Madison, WI 53718-3011 | 2015-07-21 |
| 1891761383 | William L Campbell | Anesthesiologist Assistant | 4830 Woodburn Dr, Madison, WI 53711-1346 | 2006-02-24 |
| 1366418840 | Jamie F Fridirici | Anesthesiologist Assistant | 9401 Whippoorwill Way, Middleton, WI 53562-5643 | 2006-02-24 |
| 1790392736 | Rachel Mcallister | Anesthesiologist Assistant | 600 Highland Ave, Madison, WI 53792-0001 | 2020-09-24 |
| 1831705664 | Fauzan Ali | Anesthesiologist Assistant | 2900 W Oklahoma Ave, Milwaukee, WI 53215-4330 | 2020-09-17 |
| 1942815063 | Riley S Bertram | Anesthesiologist Assistant | 202 South Park Street, 4 Tower, Madison, WI 53715 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.