Healthcare Provider Details

I. General information

NPI: 1265701452
Provider Name (Legal Business Name): WILLIAM CORONA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DESAIX DR
GEORGETOWN TX
78628-2195
US

IV. Provider business mailing address

909 DESAIX DR
GEORGETOWN TX
78628-2195
US

V. Phone/Fax

Practice location:
  • Phone: 512-680-4652
  • Fax:
Mailing address:
  • Phone: 512-680-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number87905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: