Provider Demographics
NPI:1356324776
Name:WITKOWSKI, SARAH E (CRNA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 300087
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0002
Mailing Address - Country:US
Mailing Address - Phone:512-407-8444
Mailing Address - Fax:512-407-8097
Practice Address - Street 1:2304 HANCOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2540
Practice Address - Country:US
Practice Address - Phone:512-407-8444
Practice Address - Fax:512-407-8097
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86967UOtherBC
TXP00430222Medicare PIN
8G9221Medicare PIN
TX86967UOtherBC
P00456716Medicare PIN
8J9141Medicare PIN