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NPI Code Detail

MEDICARE: LINDA MARIE PETERSON CRNA

MEDICARE:   LINDA MARIE PETERSON  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 Anesthetist650620TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182322UOTHERTXBLUE

General Provider Information

NPI Number : 1801890546
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA MARIE PETERSON CRNA
Provider Business Mailing Address
First Line : 202 SANDPIPER DR
Second Line :
City : PORTLAND
State : TX
Zip : 78374-4101
Country : US
Telephone Number : 361-777-0282
Fax Number :
Provider Business Practice Location Address
First Line : 202 SANDPIPER DR
Second Line :
City : PORTLAND
State : TX
Zip : 78374-4101
Country : US
Telephone Number : 361-777-0282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 03/20/2008

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Directions to “ LINDA MARIE PETERSON CRNA” Practice Location

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