Provider Demographics
NPI:1144206475
Name:NORMAN, DAVID (CRNA, DNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA, DNP
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9528
Mailing Address - Country:US
Mailing Address - Phone:125-472-4211
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST MEDICAL BLVD
Practice Address - Street 2:HILLCREST BAPTIST MEDICAL CENTER
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-202-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144206475OtherSCOTT & WHITE