Provider Demographics
NPI:1548246937
Name:ROTHPLETZ, TONI JEAN (CRNA)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:JEAN
Last Name:ROTHPLETZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:JEAN
Other - Last Name:MURPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6800 DEL NORTE LN
Mailing Address - Street 2:137
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2554
Mailing Address - Country:US
Mailing Address - Phone:214-522-5290
Mailing Address - Fax:214-520-3606
Practice Address - Street 1:4633 N CENTRAL EXPY
Practice Address - Street 2:SUITE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4022
Practice Address - Country:US
Practice Address - Phone:214-520-7600
Practice Address - Fax:214-528-6522
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248387RN163W00000X
TX038196CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JD14OtherBCBSTX
TX109853503Medicaid
TX109853503Medicaid