MEDICARE: TERI JANELLE HEFNER 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	565419	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82353U	OTHER	TX	BLUE CROSS/BLUE SHIELD
2	045889	OTHER	TX	AANA RECERTIFICATION

General Provider Information

NPI Number	:	1285606459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI JANELLE HEFNER CRNA

Provider Business Mailing Address
First Line	:	4107 LOFTY RIDGE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-4009
Country	:	US
Telephone Number	:	281-734-0522
Fax Number	:	281-488-5154

Provider Business Practice Location Address
First Line	:	4107 LOFTY RIDGE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-4009
Country	:	US
Telephone Number	:	281-734-0522
Fax Number	:	281-488-5154

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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