Provider Demographics
NPI:1154304517
Name:MCGARRIGLE, ILENE JULIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:JULIE
Last Name:MCGARRIGLE
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 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:512-454-2454
Mailing Address - Fax:512-454-1532
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 570
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-454-2454
Practice Address - Fax:512-454-1532
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP101881367500000X
TX32767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80227COtherBC/BS
TX2167701Medicaid
TX2167701Medicaid
S18398Medicare UPIN