Provider Demographics
NPI:1487855102
Name:MATEJKA, JEANNE RENEE (CRNA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:RENEE
Last Name:MATEJKA
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:PO BOX 926098
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-6098
Mailing Address - Country:US
Mailing Address - Phone:713-426-1669
Mailing Address - Fax:713-868-9416
Practice Address - Street 1:6200 SAVOY DR STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3320
Practice Address - Country:US
Practice Address - Phone:713-426-1669
Practice Address - Fax:713-868-9416
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016138367500000X
TX435864163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109930105Medicaid
TX83697UOtherBCBS INDIVIDUAL PROV #