Organization
LAKE TIME CRNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECE PANNELL (OFF MGR)
(817) 294-7444
Entity
Organization
Contact information
Practice address
9301 N CENTRAL EXPY, SUITE 1000W, DALLAS, TX 75231-0806
(214) 265-2810
Mailing address
PO BOX 2626, FORT WORTH, TX 76113-2626
(817) 294-7444
(817) 294-7172
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
661498
TX
Other
Enumeration date
02/04/2016
Last updated
04/11/2016
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