MEDICARE: MR. STEPHEN WAYNE SANDERSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	534642	TX

General Provider Information

NPI Number	:	1114027745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN WAYNE SANDERSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 70333
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77270-0333
Country	:	US
Telephone Number	:	832-549-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 CLINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-6128
Country	:	US
Telephone Number	:	832-549-4403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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