Provider Demographics
NPI:1003880089
Name:LANDRY, DONNA M (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:LANDRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 300087
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0002
Mailing Address - Country:US
Mailing Address - Phone:512-413-8723
Mailing Address - Fax:512-407-7105
Practice Address - Street 1:2304 HANCOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2540
Practice Address - Country:US
Practice Address - Phone:512-407-8444
Practice Address - Fax:512-407-8097
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003074405Medicaid
TX003074403Medicaid
P00121593OtherMEDICARE RAILROAD
P00014041OtherMEDICARE RAILROAD
TX247688OtherRN LICENSE
R70254Medicare UPIN
P00014041OtherMEDICARE RAILROAD
TX003074403Medicaid
TXP00121593Medicare PIN