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NPI Code Detail

MEDICARE: PONDA ELIZABETH SALLEE CRNA

MEDICARE: PONDA ELIZABETH SALLEE 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 Anesthetist508783TX
2367500000XCertified Registered Nurse Anesthetist2008029161MO

General Provider Information

NPI Number : 1497740294
Entity Type Code : Individual
Provider Name (Legal Business Name) : PONDA ELIZABETH SALLEE CRNA
Provider Business Mailing Address
First Line : 1002 GEMINI ST STE 128
Second Line :
City : HOUSTON
State : TX
Zip : 77058-2746
Country : US
Telephone Number : 281-218-9515
Fax Number :
Provider Business Practice Location Address
First Line : 1002 GEMINI ST STE 128
Second Line :
City : HOUSTON
State : TX
Zip : 77058-2746
Country : US
Telephone Number : 281-218-9515
Fax Number : 281-218-9534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2005
Last Update Date : 12/13/2016

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Directions to “ PONDA ELIZABETH SALLEE CRNA” Practice Location

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