Organization · NPI-2

Glenwood Anesthesia Management

Nurse Anesthetist, Certified Registered · Addison, TX

NPI number1073976684

StatusActive

Last updated in NPPESApr 20, 2016

Details

NPI: 1073976684
Entity type: Organization (NPI-2)
Legal business name: Glenwood Anesthesia Management
Organization subpart: No
Enumeration date: Mar 31, 2016
Last updated: Apr 20, 2016

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
367500000X	Nurse Anesthetist, Certified Registered	–	–	Yes
261QP3300X	Clinic/Center, Pain	–	–

Practice location

17051 Dallas Pkwy
Suite 100
Addison, TX 75001-7109

Phone 972-916-0521 · Fax 972-234-0212

Mailing address

17051 Dallas Pkwy
Suite 100
Addison, TX 75001-7109

Phone 972-916-0521 · Fax 972-234-0212

Authorized official

Tracy Walls
President
9722344740

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