Provider Demographics
NPI:1104097583
Name:MEYER, MARTHA C (CRNA)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:MEYER
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 1:4800 ALBERTA AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2709
Mailing Address - Country:US
Mailing Address - Phone:915-545-6720
Mailing Address - Fax:915-545-5755
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-545-6720
Practice Address - Fax:915-545-6984
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX753666367500000X
KY1095320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193067904Medicaid
TXTXB152947OtherMEDICARE
TX193067903Medicaid
NM64127052Medicaid
TX193067902Medicaid
TX89978UOtherBCBS
TX193067903Medicaid