Basic Information
| Provider Information | |||||||||
| NPI: | 1851354435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGENDOBLER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | LIANA | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 DOCTORS PARK | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733349606 | ||||||||
| FaxNumber: | 5733349608 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 DOCTORS PARK | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733349606 | ||||||||
| FaxNumber: | 5733349608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 128771 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 166636 | 01 | MO | BCBS | OTHER | 430080191 | 01 | MO | RAILROAD MEDICARE | OTHER | A141 | 01 | MO | CHAMPUS TRICARE | OTHER | 915274013 | 05 | MO | MEDICAID | 110375 | 01 | MO | HEALTH LINK | OTHER |