Provider Demographics
NPI:1851372734
Name:BERTRAND, ANITA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:MICKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2411 FOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4817
Mailing Address - Country:US
Mailing Address - Phone:713-620-4000
Mailing Address - Fax:
Practice Address - Street 1:2411 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4817
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644316367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8637UAOtherBLUE CROSS BLUE SHIELD
TX82949UOtherBLUE CROSS/BLUE SHIELD
TX8654UUOtherBLUE CROSS BLUE SHIELD
TXP00905289OtherRAILROAD MEDICARE
TX002975306Medicaid
LA2169581Medicaid
TX002975305Medicaid
TX430078988OtherRAILROAD MEDICARE
TX002975302Medicaid
TX050595OtherAANA RECERTIFICATION
TX8637UAOtherBLUE CROSS BLUE SHIELD
TX8L20740Medicare PIN
TX002975306Medicaid
TXTXB112592Medicare PIN