Healthcare Provider Details

I. General information

NPI: 1679600282
Provider Name (Legal Business Name): CARL A CHERAMIE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 NORTHWEST BLVD
FRANKLIN LA
70538-3407
US

IV. Provider business mailing address

5714 BONAIRE DRIVE
MONROE LA
71203
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-0760
  • Fax: 337-828-5024
Mailing address:
  • Phone: 337-380-1822
  • Fax: 337-828-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN035461
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: