MEDICARE: MAGGIE B. MOWERY 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	648007	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619928595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE B. MOWERY CRNA

Provider Business Mailing Address
First Line	:	2000 E LAMAR BLVD
Second Line	:	SUITE 400
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7346
Country	:	US
Telephone Number	:	817-861-3994
Fax Number	:	706-650-1034

Provider Business Practice Location Address
First Line	:	2000 E LAMAR BLVD
Second Line	:	SUITE 400
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7346
Country	:	US
Telephone Number	:	817-861-3994
Fax Number	:	706-650-1034

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	06/30/2014

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