Individual
KATHLEEN A. VANWAGENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, MSN
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
538523
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2366502
—
TX
01
—
84367U
BCBS
TX
01
—
P00379734
RR MEDICARE
TX
Enumeration date
10/11/2006
Last updated
03/16/2011
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