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NPI Code Detail

MEDICARE: MRS. JEANIECE P MUKHERJEE CRNA

MEDICARE:  MRS. JEANIECE P MUKHERJEE  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist678919TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100N47FOTHERTXMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4140442853OTHERTXCSHCN GROUP NUMBER
5199310703OTHERTXCSHCN
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407093735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANIECE P MUKHERJEE CRNA
Provider Business Mailing Address
First Line : PO BOX 162835
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-2835
Country : US
Telephone Number : 817-334-0530
Fax Number : 817-334-0235
Provider Business Practice Location Address
First Line : 1000 LIPSCOMB ST STE 110
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3181
Country : US
Telephone Number : 817-348-8600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2009
Last Update Date : 09/10/2020

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Directions to “ MRS. JEANIECE P MUKHERJEE CRNA” Practice Location

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