Provider Demographics
NPI:1376509208
Name:TODD, MARY ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:COGDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8210 SEASHORE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5312
Mailing Address - Country:US
Mailing Address - Phone:361-548-6702
Mailing Address - Fax:
Practice Address - Street 1:6130 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2455
Practice Address - Country:US
Practice Address - Phone:361-853-2200
Practice Address - Fax:361-882-4891
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP102253367500000X
TX250467367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109764404Medicaid
TX82464UOtherBCBSTX
TX8703B8Medicare PIN