Provider Demographics
NPI:1114974920
Name:SREMBO, DOROTHY J (CRNA)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:SREMBO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33486
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-3486
Mailing Address - Country:US
Mailing Address - Phone:210-654-0298
Mailing Address - Fax:
Practice Address - Street 1:8623 AUTUMN SUNSET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-2656
Practice Address - Country:US
Practice Address - Phone:210-654-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered