Healthcare Provider Details

I. General information

NPI: 1205076833
Provider Name (Legal Business Name): GREGORY ALLEN STRICKLAND JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2009
Last Update Date: 02/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

6301 TIOGA CT
BOSSIER CITY LA
71112-5005
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2557
  • Fax:
Mailing address:
  • Phone: 318-453-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN106307 AP05674
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: