MEDICARE: MRS. LEE L WEBBER 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
1	163W00000X	Registered Nurse	041.414315	IL
2	163WP0000X	Pain Management Registered Nurse	209.010736	IL
3	367500000X	Certified Registered Nurse Anesthetist	209.010736	IL
4	367500000X	Certified Registered Nurse Anesthetist	1073767	TX

General Provider Information

NPI Number	:	1518228600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEE L WEBBER CRNA

Provider Business Mailing Address
First Line	:	3839 MCKINNEY AVE STE 155-814
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1413
Country	:	US
Telephone Number	:	214-449-0110
Fax Number	:	469-850-6803

Provider Business Practice Location Address
First Line	:	3839 MCKINNEY AVE STE 155-814
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1413
Country	:	US
Telephone Number	:	214-449-0110
Fax Number	:	469-850-6803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	07/27/2024

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