Healthcare Provider Details

I. General information

NPI: 1528111853
Provider Name (Legal Business Name): CHRISTY DUCOTE EAVES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14285 WATERLOO DRIVE
VENTRESS LA
70783
US

IV. Provider business mailing address

14285 WATERLOO DRIVE
VENTRESS LA
70783
US

V. Phone/Fax

Practice location:
  • Phone: 225-638-9817
  • Fax:
Mailing address:
  • Phone: 225-638-9817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04546
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: