Provider Demographics
NPI:1679627723
Name:WALDO, MEREDITH L (CRNA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:L
Last Name:WALDO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:L
Other - Last Name:EGLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5909
Mailing Address - Country:US
Mailing Address - Phone:903-891-7000
Mailing Address - Fax:903-893-5334
Practice Address - Street 1:500 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7354
Practice Address - Country:US
Practice Address - Phone:903-891-7000
Practice Address - Fax:903-893-5334
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y2855OtherBLUE CROSS BLUE SHIELD
TX190413802Medicaid
TX8Y2855OtherBLUE CROSS BLUE SHIELD