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General NPI Number Information
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NPI Number | 1891834321
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Entity Type | Individual
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Provider Name | EDWIN PALMER NALLEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 12222 N CENTRAL EXPY STE 400
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City | DALLAS
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State | TX
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Zip | 75243-3755
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Country | US
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Telephone | 469-218-0678
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Fax | 469-587-6684
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Provider Business Mailing Address
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Address Line | 12222 N CENTRAL EXPY STE 400
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City | DALLAS
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State | TX
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Zip | 75243-3755
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Country | US
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Telephone | 469-218-0678
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Fax | 469-587-6684
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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 | C02651
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License Number State | AR
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