Healthcare Provider Details

I. General information

NPI: 1710209994
Provider Name (Legal Business Name): CLARA M ALLEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

1717 MAIN ST 5200
DALLAS TX
75201-4612
US

V. Phone/Fax

Practice location:
  • Phone: 214-932-1030
  • Fax: 903-257-0896
Mailing address:
  • Phone: 214-932-1030
  • Fax: 903-257-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN06039
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: