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General NPI Number Information
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NPI Number | 1326016007
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Entity Type | Individual
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Provider Name | ELLEN PENTECOST MCPHATE CRNA, MS
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 2411 FOUNTAIN VIEW DR STE. 200
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City | HOUSTON
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State | TX
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Zip | 77057-4817
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Country | US
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Telephone | 713-620-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 FOUNTAIN VIEW DR STE. 200
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City | HOUSTON
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State | TX
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Zip | 77057-4817
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Country | US
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Telephone | 713-620-4000
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 48816-1470
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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 | 731706
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License Number State | TX
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