Provider Demographics
NPI:1225381593
Name:ADERA, ADOLPHUS OWINO (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ADOLPHUS
Middle Name:OWINO
Last Name:ADERA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E CAMELLIA AVE
Mailing Address - Street 2:APT 56
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5561
Mailing Address - Country:US
Mailing Address - Phone:610-639-1697
Mailing Address - Fax:
Practice Address - Street 1:2010 S CYNTHIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1386
Practice Address - Country:US
Practice Address - Phone:956-664-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819420367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered