Provider Demographics
NPI:1235422932
Name:KOROMPAI, ERICA MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MARIE
Last Name:KOROMPAI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:EDGINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 732041
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2041
Mailing Address - Country:US
Mailing Address - Phone:903-315-2000
Mailing Address - Fax:
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered