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General NPI Number Information
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NPI Number | 1154376721
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Entity Type | Individual
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Provider Name | HOWARD DWAYNE CREDOR CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 7946 N LOOP 1604 W
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City | SAN ANTONIO
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State | TX
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Zip | 78249-5174
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Country | US
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Telephone | 210-567-9100
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Fax | 210-450-2165
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Provider Business Mailing Address
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Address Line | 7946 N LOOP 1604 W
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City | SAN ANTONIO
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State | TX
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Zip | 78249-5174
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Country | US
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Telephone | 210-567-9100
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Fax | 210-450-2165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN074876
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 704230
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP113139
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License Number State | TX
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