Healthcare Provider Details

I. General information

NPI: 1720196694
Provider Name (Legal Business Name): CORRINE CATHERINE MONTELARO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORRINE MONTELARO BECHTOLD CRNA

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 301
BATON ROUGE LA
70808-0319
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 225-214-6436
  • Fax: 225-214-6437
Mailing address:
  • Phone: 713-620-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05655
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number074701
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP117000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: