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General NPI Number Information
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NPI Number | 1861935686
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Entity Type | Individual
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Provider Name | COURTNEY ARCHIE CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 1700 LINDBERG DR
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City | SLIDELL
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State | LA
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Zip | 70458-8062
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Country | US
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Telephone | 985-661-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 105 RICHLAND DR W
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City | MANDEVILLE
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State | LA
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Zip | 70448-6332
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Country | US
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Telephone | 225-328-2425
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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 | APRN11026167
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License Number State | FL
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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 | AP09067
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License Number State | LA
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