Provider Demographics
NPI:1588036172
Name:DUNAWAY, MARY JANE GALLARDO (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:GALLARDO
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:MARY JANE
Other - Middle Name:ABAYON
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-2408
Mailing Address - Fax:432-640-4606
Practice Address - Street 1:500 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5001
Practice Address - Country:US
Practice Address - Phone:432-640-2408
Practice Address - Fax:432-640-4606
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129523367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered