Provider Demographics
NPI:1609863604
Name:WHITEFIELD, SHIRLEY CAMPBELL (CRNA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CAMPBELL
Last Name:WHITEFIELD
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 3945
Mailing Address - Street 2:DEPT 453
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3945
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?:No
Enumeration Date:2005-10-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236398367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120062805Medicaid
TXP00379493OtherRR MCR - TAC HOUSTON
TX430069190OtherRAILROAD MEDICARE
TX035790OtherRECERTIFICATION AANA
TX120062806Medicaid
TX81976UOtherBLUE CROSS BLUE SHIELD
LA1501361Medicaid
TX85290UOtherBLUE CROSS BLUE SHIELD
TX035790OtherRECERTIFICATION AANA
R57332Medicare UPIN
LA1501361Medicaid