Provider Demographics
NPI:1306081021
Name:STATUM, WINFRED III (CRNA)
Entity type:Individual
Prefix:
First Name:WINFRED
Middle Name:
Last Name:STATUM
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:17207 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8423
Mailing Address - Country:US
Mailing Address - Phone:832-698-5331
Mailing Address - Fax:832-698-5171
Practice Address - Street 1:17207 KUYKENDAHL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8423
Practice Address - Country:US
Practice Address - Phone:832-698-5331
Practice Address - Fax:832-698-5171
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0620181367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered