Healthcare Provider Details

I. General information

NPI: 1619913779
Provider Name (Legal Business Name): ANDREW GRESHAM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S MCCOLL RD
EDINBURG TX
78539-9152
US

IV. Provider business mailing address

201 AUBURN AVE
MCALLEN TX
78504-1994
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-0529
  • Fax:
Mailing address:
  • Phone: 956-566-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN530525L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3314
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number775203
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number719644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: