Healthcare Provider Details

I. General information

NPI: 1760638308
Provider Name (Legal Business Name): JULIE B HARRIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N ACADIA RD
THIBODAUX LA
70301-4847
US

IV. Provider business mailing address

PO BOX 5478
THIBODAUX LA
70302-5478
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-5500
  • Fax:
Mailing address:
  • Phone: 985-447-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05506
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: