Healthcare Provider Details

I. General information

NPI: 1770646192
Provider Name (Legal Business Name): EMILY ALLISON GLASSNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SOUTH ROCK STREET WESTLAKE ANESTHESIA GROUP, PA
GEORGETOWN TX
78626
US

IV. Provider business mailing address

1004 SOUTH ROCK STREET WESTLAKE ANESTHESIA GROUP, PA
GEORGETOWN TX
78626
US

V. Phone/Fax

Practice location:
  • Phone: 512-279-0348
  • Fax: 512-371-8788
Mailing address:
  • Phone: 512-279-0348
  • Fax: 512-371-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1492572052
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2004008595
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55562
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP119157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: