MEDICARE: TANITHA MICHELLE ULANOWSKI 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	367500000X	Certified Registered Nurse Anesthetist	718135	TX

General Provider Information

NPI Number	:	1730475716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANITHA MICHELLE ULANOWSKI CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1374
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33302-1374
Country	:	US
Telephone Number	:	214-458-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 GRANT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-2836
Country	:	US
Telephone Number	:	713-227-4600
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/28/2011

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