Healthcare Provider Details

I. General information

NPI: 1811012115
Provider Name (Legal Business Name): LOIS REMELY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WANKEL WAY
OXNARD CA
93030
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-1908
  • Fax:
Mailing address:
  • Phone: 656-795-6596
  • Fax: 770-701-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number325709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: