Provider Demographics
NPI:1992792766
Name:SANDERLIN, LINDA FAYE (CRNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:SANDERLIN
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:PO BOX 4346
Mailing Address - Street 2:DEPT 398
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-335-1700
Practice Address - Fax:281-335-1708
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX430528367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022419OtherRECERTIFICATION AANA
TX85997UOtherBLUE CROSS/BLUE SHIELD
TX82848UOtherBLUE CROSS BLUE SHIELD
TX85287UOtherBLUE CROSS BLUE SHIELD
TX85287UOtherBLUE CROSS BLUE SHIELD
TX82848UOtherBLUE CROSS BLUE SHIELD
R59963Medicare UPIN
TX8A7427Medicare ID - Type Unspecified
TX8G3555Medicare ID - Type Unspecified