Individual
CAROL CRANDALL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 CITYWEST BLVD, STE. 300, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP103255
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1182478
LOUISIANA MEDICAID
LA
05
—
137087608
—
TX
05
—
137087613
—
TX
01
—
430056553
RAILROAD MEDICARE
—
01
—
81324U
TX-BLUE SHIELD
—
Enumeration date
01/16/2007
Last updated
02/14/2017
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