Provider Demographics
NPI:1164670493
Name:WADDELL, GINGER (CRNA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:WADDELL
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 1:1710 E SAUNDERS ST
Mailing Address - Street 2:SUITE 384
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5443
Mailing Address - Country:US
Mailing Address - Phone:956-523-8875
Mailing Address - Fax:956-523-8689
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:SUITE 384
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-523-8875
Practice Address - Fax:956-523-8689
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000139819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered