Healthcare Provider Details

I. General information

NPI: 1194166389
Provider Name (Legal Business Name): LANCE JAMES OLIVIER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SLIDELL LA
70461-5520
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
SLIDELL LA
70461-5520
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-5082
  • Fax:
Mailing address:
  • Phone: 985-646-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP07448
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN118955
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: