Healthcare Provider Details

I. General information

NPI: 1245562800
Provider Name (Legal Business Name): LAKEIDRIA RANDALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAKEIDRIA RANDALL CRNA

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE. 301
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE. 301
BATON ROUGE LA
70808-4300
US

V. Phone/Fax

Practice location:
  • Phone: 214-592-2957
  • Fax: 225-214-6437
Mailing address:
  • Phone: 214-592-2957
  • Fax: 225-214-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number112518
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP07633
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: