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General NPI Number Information
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NPI Number | 1801879754
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Entity Type | Individual
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Provider Name | LATONYA S MIMS CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 2427 LAKECREST DR
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City | SHREVEPORT
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State | LA
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Zip | 71109-3003
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Country | US
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Telephone | 318-560-2312
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Fax |
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Provider Business Mailing Address
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Address Line | 2427 LAKECREST DR
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City | SHREVEPORT
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State | LA
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Zip | 71109-3003
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Country | US
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Telephone | 318-560-2312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN243434
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 668574
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License Number State | TX
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