Individual
DIANE LYNN WEGELT-WUNDROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 N TEXAS AVE, WEBSTER, TX 77598-4966
(281) 335-1700
(281) 335-1708
Mailing address
PO BOX 4346, DEPT 398, HOUSTON, TX 77210-4346
(281) 358-8114
(281) 358-0609
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
512064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033610
AANA RECERTIFICATION
TX
01
—
10069098
AMERIGROUP
TX
01
—
86155U
BLUE CROSS/BLUE SHIELD
TX
01
—
P0036114
RAILROAD MEDICARE
TX
Enumeration date
04/13/2006
Last updated
07/08/2007
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