Individual
MRS. JEANIECE P MUKHERJEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 LIPSCOMB ST STE 110, FORT WORTH, TX 76104-3181
(817) 348-8600
Mailing address
PO BOX 162835, FORT WORTH, TX 76161-2835
(817) 334-0530
(817) 334-0235
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
678919
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N47F
MEDICARE GROUP NUMBER
TX
01
—
137345809
MEDICAID GROUP NUMBER
TX
01
—
140442853
CSHCN GROUP NUMBER
TX
05
—
199310702
—
TX
01
—
199310703
CSHCN
TX
05
—
199310708
—
TX
Enumeration date
01/08/2009
Last updated
09/10/2020
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