1831160415 NPI number — DANA BROOKS ROBERSON CRNA

Table of content: SARA COOK FNP (NPI 1174965966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831160415 NPI number — DANA BROOKS ROBERSON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
DANA
Provider Middle Name:
BROOKS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831160415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 E DEBBIE LN
Provider Second Line Business Mailing Address:
SUITE 102-144
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-233-8862
Provider Business Mailing Address Fax Number:
866-842-4031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5323 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-648-7834
Provider Business Practice Location Address Fax Number:
214-645-0078
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  505356 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821080284 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831160415 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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