Provider Demographics
NPI:1558802371
Name:REDMALLET ANESTHESIA PLLC
Entity Type:Organization
Organization Name:REDMALLET ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:956-459-6795
Mailing Address - Street 1:2075 SUNSET LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9280
Mailing Address - Country:US
Mailing Address - Phone:956-459-6795
Mailing Address - Fax:
Practice Address - Street 1:925 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3955
Practice Address - Country:US
Practice Address - Phone:575-523-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty