Provider Demographics
NPI:1013974047
Name:WEGNER, MARY CATHERINE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:WEGNER
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 1:4444 CORONA
Mailing Address - Street 2:SUITE 232
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-857-8525
Mailing Address - Fax:361-857-8809
Practice Address - Street 1:5950 SARATOGA BLVD
Practice Address - Street 2:CHRISTUS SPOHN SOUTH
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-985-5700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX465279367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84020COtherBCBS
TX84020COtherBCBS