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LEE AUSTIN CRNA
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1467511881
Individual Registrant: LEE AUSTIN CRNA
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
650 SANITARIUM RD DEER PARK, CA 94576 US
Tel: 707-963-3611 Fax: 707-967-5622
Tel: 707-963-3611 Fax: 707-967-5622
Contact information for business:
PO BOX 7096 STOCKTON, CA 95267-0096 US
Tel: 209-956-7725 Fax: 209-956-7733
Tel: 209-956-7725 Fax: 209-956-7733
Registration Information:
NPI: 1467511881
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 163W00000X | Nursing Service Providers Registered Nurse | CA | RN592567 |
| Y | 367500000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered | CA | NA2796 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| RN5925670 | CA | 05 | |
| US DEPT OF LABOR | 359252000 | CA | 01 |
| BLUE SHIELD OF CA | NA0027960 | CA | 01 |
