Healthcare Provider Details

I. General information

NPI: 1417939075
Provider Name (Legal Business Name): HEATHER L CUELLAR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER L DOUCHA CRNA

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 N MOPAC EXPY STE 3-210
AUSTIN TX
78759-8862
US

IV. Provider business mailing address

8140 N MOPAC EXPY STE 3-210
AUSTIN TX
78759-8862
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-2292
  • Fax: 512-343-2745
Mailing address:
  • Phone: 512-493-9227
  • Fax: 512-343-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number70963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: