Provider Demographics
NPI:1386793503
Name:EDERA, CHRISTINE ROSE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ROSE
Last Name:EDERA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:ROSE
Other - Last Name:BERLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7117 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5835
Mailing Address - Country:US
Mailing Address - Phone:832-264-4219
Mailing Address - Fax:
Practice Address - Street 1:7117 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5835
Practice Address - Country:US
Practice Address - Phone:832-264-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33299367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109834504OtherIN HARRIS - MEDICAID
TX002295602OtherOUT HARRIS - MEDICAID
81302UOtherTX-BLUE SHIELD
87032HMedicare PIN
81302UOtherTX-BLUE SHIELD
430056441Medicare PIN