Healthcare Provider Details

I. General information

NPI: 1073551453
Provider Name (Legal Business Name): DREAMWISE ANESTHESIA ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W FRANK AVE
LUFKIN TX
75904-3357
US

IV. Provider business mailing address

PO BOX 1447
LUFKIN TX
75902-1447
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-3036
  • Fax:
Mailing address:
  • Phone: 936-639-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN JOHNSON
Title or Position: MANAGER
Credential: CRNA
Phone: 936-639-3036