Healthcare Provider Details

I. General information

NPI: 1861935686
Provider Name (Legal Business Name): COURTNEY ARCHIE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LINDBERG DR
SLIDELL LA
70458-8062
US

IV. Provider business mailing address

105 RICHLAND DR W
MANDEVILLE LA
70448-6332
US

V. Phone/Fax

Practice location:
  • Phone: 985-661-2151
  • Fax:
Mailing address:
  • Phone: 225-328-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11026167
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP09067
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: