MEDICARE: LEE ANN MCDANIEL 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	28146064	IN
2	367500000X	Certified Registered Nurse Anesthetist	1033522	TX

General Provider Information

NPI Number	:	1760463228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANN MCDANIEL CRNA

Provider Business Mailing Address
First Line	:	20 CLEAR CREEK RANCH RD
Second Line	:
City	:	ROSSTON
State	:	TX
Zip	:	76263-2530
Country	:	US
Telephone Number	:	260-251-0458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 11TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4300
Country	:	US
Telephone Number	:	940-764-7000
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	02/06/2022

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