Healthcare Provider Details

I. General information

NPI: 1891907002
Provider Name (Legal Business Name): PATRICK JOHN TRAINOR JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

IV. Provider business mailing address

100 MEDICAL CENTER DRIVE
SLIDELL LA
70461-5520
US

V. Phone/Fax

Practice location:
  • Phone: 504-779-5515
  • Fax: 504-779-5568
Mailing address:
  • Phone: 985-649-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105235
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: