Individual
MRS. JULIE WYNNE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP108783
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002132101
—
TX
05
—
002132102
—
TX
01
—
430039940
RAILROAD MEDICARE
TX
01
—
81108U
TX-BLUE SHIELD
—
01
—
P01748561
RR MEDICARE
TX
Enumeration date
01/04/2007
Last updated
04/20/2020
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