Provider Demographics
NPI:1346731239
Name:MCCORD, SUSAN RAE (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:MCCORD
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 1:2300 WOLF RANCH PKWY APT 4315
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7296
Mailing Address - Country:US
Mailing Address - Phone:254-371-3582
Mailing Address - Fax:
Practice Address - Street 1:8140 N MOPAC EXPY STE 3-210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8859
Practice Address - Country:US
Practice Address - Phone:512-493-9237
Practice Address - Fax:512-343-2745
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79620163W00000X
TXAP138089367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse