Provider Demographics
NPI:1104976687
Name:GURLEY-DRAINE, PATRICE M (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:GURLEY-DRAINE
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 1:4615 SCHILLER PARK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5412
Mailing Address - Country:US
Mailing Address - Phone:832-969-6442
Mailing Address - Fax:
Practice Address - Street 1:4615 SCHILLER PARK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5412
Practice Address - Country:US
Practice Address - Phone:832-969-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX073068367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00257238OtherRAILROAD MEDICARE
TX85187UOtherBLUE CROSS
TX88656UOtherBLUE CROSS BLUE SHIELD
TX173359401Medicaid
TX85187UOtherBLUE CROSS
TX88656UOtherBLUE CROSS BLUE SHIELD