Provider Demographics
NPI:1245212331
Name:DEXTER, JUDITH E (CRNA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:DEXTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4740 INGERSOLL ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6697
Mailing Address - Country:US
Mailing Address - Phone:713-263-8780
Mailing Address - Fax:713-263-8563
Practice Address - Street 1:4740 INGERSOLL STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6624
Practice Address - Country:US
Practice Address - Phone:713-263-8780
Practice Address - Fax:713-263-8563
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX228779367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088947904Medicaid
TXP0117040OtherRAILROAD MEDICARE
TX088947905Medicaid
TX088947905Medicaid