Diane L Hartzog, CRNA in Watertown, WI - Anesthesiologist Assistant

Diane L Hartzog, CRNA is a Anesthesiologist Assistant based in Watertown, Wisconsin. Diane L Hartzog is licensed to practice in Wisconsin (license number 78920030) and her current practice location is 125 Hospital Drive, Watertown, Wisconsin. She can be reached at her office (for appointments etc.) via phone at (920) 262-4450.

NPI number for Diane L Hartzog is 1871538744 and her current mailing address is 4555 West Schroeder Drive, Suite 170, Milwaukee, Wisconsin. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1871538744.

Contact Information

	Diane L Hartzog, CRNA
	125 Hospital Drive, Watertown, WI 53098
	(920) 262-4450
	Not Available

Provider's Profile

Full Name	Diane L Hartzog
Gender	Female
Speciality	Anesthesiologist Assistant
Location	125 Hospital Drive, Watertown, Wisconsin
Accepts Medicare Assignments	Does not participate in Medicare Program. She may not accept medicare assignment.

NPI Data:

NPI Number: 1871538744
Provider Enumeration Date: 06/17/2006
Last Update Date: 03/27/2008

Medical Identifiers

Medical identifiers for Diane L Hartzog such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1871538744	NPI	-	NPPES
43379900	Medicaid	WI

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367H00000X	Anesthesiologist Assistant	78920030 (Wisconsin)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Diane L Hartzog is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Diane L Hartzog, CRNA 4555 West Schroeder Drive, Suite 170, Milwaukee, WI 53223 Ph: (414) 365-3210	Diane L Hartzog, CRNA 125 Hospital Drive, Watertown, WI 53098 Ph: (920) 262-4450

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Diane L Hartzog, CRNA - Anesthesiologist Assistant in Watertown, WI