Healthcare Provider Details

I. General information

NPI: 1831806041
Provider Name (Legal Business Name): MAIMOONA QAZI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N
ALLEN TX
75013-6103
US

IV. Provider business mailing address

PO BOX 800129
DALLAS TX
75380-0129
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-1000
  • Fax:
Mailing address:
  • Phone: 888-324-7432
  • Fax: 972-528-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1097168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: