Individual
JEATHRINA BERSOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 CITYWEST BLVD, HOUSTON, TX 77042-2300
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP118669
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211163501
—
TX
01
—
8048UA
BLUE CROSS BLUE SHIELD
TX
01
—
P00826712
RAILROAD MEDICARE
TX
Enumeration date
06/10/2009
Last updated
04/30/2020
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