Provider Demographics
NPI:1134101595
Name:FOX, LORRAINE A (CRNA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:FOX
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 2859
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78381-2859
Mailing Address - Country:US
Mailing Address - Phone:512-963-0731
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR STE 232
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4323
Practice Address - Country:US
Practice Address - Phone:512-963-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50785367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152967901Medicaid
TX82257UOtherBC/BS
87983HMedicare ID - Type Unspecified
TX152967901Medicaid