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General NPI Number Information
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NPI Number | 1730728684
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Entity Type | Individual
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Provider Name | SALLY JUNG DEFRIES CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/24/2019
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 12221 N MOPAC EXPY
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City | AUSTIN
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State | TX
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Zip | 78758-2401
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Country | US
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Telephone | 512-901-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 SCENIC DR APT 305
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City | AUSTIN
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State | TX
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Zip | 78703-2050
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Country | US
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Telephone | 512-589-4899
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 832594
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License Number State | TX
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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 | AP144692
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License Number State | TX
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