Provider Demographics
NPI:1336815620
Name:DREAMWORK ANESTHESIA
Entity Type:Organization
Organization Name:DREAMWORK ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:901-484-5157
Mailing Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1658
Mailing Address - Country:US
Mailing Address - Phone:214-592-8159
Mailing Address - Fax:949-561-5834
Practice Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1658
Practice Address - Country:US
Practice Address - Phone:214-592-8159
Practice Address - Fax:949-561-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty