Basic Information
| Provider Information | |||||||||
| NPI: | 1124250725 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENICE MARIE ESPINOSA | ||||||||
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| OtherOrganizationName: | DENICE ESPINOSA ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553874552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
| FaxNumber: | 9524423621 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 WESLAYAN ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770275727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135261600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 08/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | ESPINOSA | ||||||||
| AuthorizedOfficialFirstName: | DENICE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7135261600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 540173 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.