Basic Information
Provider Information
NPI: 1073919494
EntityType: 2
ReplacementNPI:  
OrganizationName: DREAMLAND UAP ANESTHESIA, LLC
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Mailing Information
Address1: 15305 DALLAS PKWY
Address2: 1600
City: ADDISON
State: TX
PostalCode: 750014637
CountryCode: US
TelephoneNumber: 9727133547
FaxNumber: 9725341568
Practice Location
Address1: 100 VILLAGE SQ
Address2:  
City: HAZELWOOD
State: MO
PostalCode: 630421820
CountryCode: US
TelephoneNumber: 3143738931
FaxNumber: 3143738935
Other Information
ProviderEnumerationDate: 11/12/2014
LastUpdateDate: 12/16/2014
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AuthorizedOfficialLastName: HARPER
AuthorizedOfficialFirstName: KIMBERLY
AuthorizedOfficialMiddleName: MICHELLE
AuthorizedOfficialTitleorPosition: OFFICER / ANESTHESIA PROGRAM MANAGE
AuthorizedOfficialTelephone: 9727133547
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IsOrganizationSubpart: N
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AuthorizedOfficialNamePrefix: MS.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 
367500000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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