Provider Demographics
NPI:1104888197
Name:CAMERON, ELIZABETH JENNIFER (CRNA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JENNIFER
Last Name:CAMERON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:E
Other - Last Name:MRAULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:145 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2380
Mailing Address - Country:US
Mailing Address - Phone:972-787-8152
Mailing Address - Fax:
Practice Address - Street 1:7 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7829
Practice Address - Country:US
Practice Address - Phone:855-677-8669
Practice Address - Fax:888-510-3225
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53761367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX53761OtherNBCRNA
TXAP117888OtherTEXAS BOARD OF NURSING
CA2810OtherNURSE ANESTHETIST CERT. #