Provider Demographics
NPI:1891834321
Name:NALLEY, EDWIN PALMER (CRNA)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:PALMER
Last Name:NALLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 N CENTRAL EXPY
Mailing Address - Street 2:STE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3755
Mailing Address - Country:US
Mailing Address - Phone:469-218-0678
Mailing Address - Fax:469-587-6684
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:STE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3755
Practice Address - Country:US
Practice Address - Phone:469-218-0678
Practice Address - Fax:469-587-6684
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC02651367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168548001Medicaid
AR5A192C741Medicare PIN
AR168548001Medicaid