Provider Demographics
NPI:1952388456
Name:PETERS, SANDRA K (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:PETERS
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 1:945 COUNTY ROAD 402
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2798
Mailing Address - Country:US
Mailing Address - Phone:325-247-1631
Mailing Address - Fax:325-247-1637
Practice Address - Street 1:945 COUNTY ROAD 402
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2798
Practice Address - Country:US
Practice Address - Phone:325-247-1631
Practice Address - Fax:325-247-1637
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN221655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81190HOtherBCBS
TX038463801Medicaid
R71092Medicare UPIN
TX038463801Medicaid