Healthcare Provider Details

I. General information

NPI: 1225282460
Provider Name (Legal Business Name): LINDSAY PROCELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MARSHALL AVE STE 4002
LONGVIEW TX
75601-5622
US

IV. Provider business mailing address

703 E MARSHALL AVE STE 4002
LONGVIEW TX
75601-5622
US

V. Phone/Fax

Practice location:
  • Phone: 903-236-2736
  • Fax: 903-236-2286
Mailing address:
  • Phone: 903-236-2736
  • Fax: 903-236-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number120902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: