Healthcare Provider Details

I. General information

NPI: 1891730909
Provider Name (Legal Business Name): PATRICIA P MARSE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA PASCUAL CRNA

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E LEVERT DR
LULING LA
70070-3126
US

IV. Provider business mailing address

24 E LEVERT DR
LULING LA
70070-3126
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-8628
  • Fax: 985-331-1915
Mailing address:
  • Phone: 985-785-8628
  • Fax: 985-331-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP01291
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: