Basic Information
| Provider Information | |||||||||
| NPI: | 1609863604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITEFIELD | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | CAMPBELL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3945 | ||||||||
| Address2: | DEPT 453 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813588114 | ||||||||
| FaxNumber: | 2813580609 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N TEXAS AVE | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813351700 | ||||||||
| FaxNumber: | 2813351708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 03/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 236398 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 120062805 | 05 | TX | MEDICAID | P00379493 | 01 | TX | RR MCR - TAC HOUSTON | OTHER | 430069190 | 01 | TX | RAILROAD MEDICARE | OTHER | 035790 | 01 | TX | RECERTIFICATION AANA | OTHER | 120062806 | 05 | TX | MEDICAID | 81976U | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 1501361 | 05 | LA | MEDICAID | 85290U | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |