Provider Demographics
NPI:1619928595
Name:MOWERY, MAGGIE B (CRNA)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:B
Last Name:MOWERY
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 1:2000 E LAMAR BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7346
Mailing Address - Country:US
Mailing Address - Phone:817-861-3994
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:2000 E LAMAR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7346
Practice Address - Country:US
Practice Address - Phone:817-861-3994
Practice Address - Fax:706-650-1034
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648007367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171760502Medicaid
TX8G3570Medicare PIN