Provider Demographics
NPI:1154306496
Name:WRIGHT, ROBERTA JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JANE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:JANE
Other - Last Name:PUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 398
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4925
Practice Address - Country:US
Practice Address - Phone:281-335-1700
Practice Address - Fax:281-335-1708
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX580511367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00316468OtherRAILROAD MEDICARE
048500OtherCRNA
TX85387UOtherBLUE CROSS/BLUE SHIELD
S69875Medicare UPIN
048500OtherCRNA