Healthcare Provider Details

I. General information

NPI: 1427639194
Provider Name (Legal Business Name): SARA A DORNBUSCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HOSPITAL DR
VICTORIA TX
77901-5749
US

IV. Provider business mailing address

2701 HOSPITAL DR
VICTORIA TX
77901-5749
US

V. Phone/Fax

Practice location:
  • Phone: 361-573-9181
  • Fax:
Mailing address:
  • Phone: 361-573-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number315994
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1041938
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD163522
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: