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General NPI Number Information
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NPI Number | 1932831716
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Entity Type | Individual
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Provider Name | MCKENZIE LOUIS SAMUELSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 12222 MERIT DR STE 600
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City | DALLAS
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State | TX
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Zip | 75251-3294
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Country | US
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Telephone | 972-715-5000
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Fax | 972-715-9976
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Provider Business Mailing Address
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Address Line | 1135 RIVERVIEW RNCH
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City | BRAZORIA
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State | TX
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Zip | 77422-7937
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Country | US
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Telephone | 616-240-7552
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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 | 15894
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License Number State | WI
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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 | 1210439
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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 | RN2341474
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License Number State | MA
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