Provider Demographics
NPI:1194700369
Name:HITT, ROBERT LOREN (CRNA, APN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOREN
Last Name:HITT
Suffix:
Gender:M
Credentials:CRNA, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SKIERS RUN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-4493
Mailing Address - Country:US
Mailing Address - Phone:618-439-2800
Mailing Address - Fax:618-439-2800
Practice Address - Street 1:201 BAILEY LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1969
Practice Address - Country:US
Practice Address - Phone:618-439-3161
Practice Address - Fax:618-438-8304
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205579Medicare ID - Type Unspecified
ILR00552Medicare UPIN