Provider Demographics
NPI:1184688491
Name:MCDERMOTT, WENDI L (CRNA)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:L
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
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:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116353367500000X
FLARNP9236079367500000X
NVCRNA000339367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184688491Medicaid
GA831211152AMedicaid
FLG3837OtherBLUE CROSS BLUE SHIELD
TX193900105Medicaid
FL307205300Medicaid
TXP01746002OtherRR MEDICARE
TX8695ULOtherBCBS
NVBR803YMedicare PIN
TXP01746002OtherRR MEDICARE
TX413840YK6UMedicare PIN
TX193900105Medicaid
FLG3837XMedicare PIN