| NPI | 1831280536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENETHA D MORAN Authorized Official 972-763-3893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7002462) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 7002462) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 7002462) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2017-11-14 |