Healthcare Provider Details

I. General information

NPI: 1144510520
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461
US

IV. Provider business mailing address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-5082
  • Fax: 985-649-8838
Mailing address:
  • Phone: 985-646-5082
  • Fax: 985-234-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06369
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: