Healthcare Provider Details

I. General information

NPI: 1891733226
Provider Name (Legal Business Name): TONI MARIE HOGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/25/2015
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: 512-297-0348
  • Fax: 512-371-8788
Mailing address:
  • Phone: 512-297-0348
  • Fax: 512-371-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-101220
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number180953
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9243470
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP114669
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: