MEDICARE: TONI JEAN ROTHPLETZ 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	163W00000X	Registered Nurse	248387RN	TX
2	367500000X	Certified Registered Nurse Anesthetist	038196CRNA	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00JD14	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548246937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI JEAN ROTHPLETZ CRNA

Provider Business Mailing Address
First Line	:	6800 DEL NORTE LN
Second Line	:	137
City	:	DALLAS
State	:	TX
Zip	:	75225-2554
Country	:	US
Telephone Number	:	214-522-5290
Fax Number	:	214-520-3606

Provider Business Practice Location Address
First Line	:	4633 N CENTRAL EXPY
Second Line	:	SUITE 310
City	:	DALLAS
State	:	TX
Zip	:	75205-4022
Country	:	US
Telephone Number	:	214-520-7600
Fax Number	:	214-528-6522

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/29/2011

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