=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407323538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIESTA SOLUTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2018
-----------------------------------------------------
Last Update Date | 10/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 N HIGHLAND AVE STE 220
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-7383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-345-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4475 TRINITY MILLS ROAD #703064
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75370-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-416-6321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEP
-----------------------------------------------------
Name | DAN WANN
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 209-416-6321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------