=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578556395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANNE A HARPER CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2005
-----------------------------------------------------
Last Update Date | 10/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2495 SHREVEPORT HWY # 71N
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-466-2957
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 69004
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71306-9004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-466-2957
-----------------------------------------------------
Fax | 318-473-4340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | AP03944
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN01986
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------