Healthcare Provider Details

I. General information

NPI: 1598026718
Provider Name (Legal Business Name): DION INGRAM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4800 ALBERTA AVE SUITE 101
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-6560
  • Fax: 915-545-6984
Mailing address:
  • Phone: 915-545-6720
  • Fax: 915-545-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9264965
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number826307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: