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General NPI Number Information
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NPI Number | 1982728739
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Entity Type | Individual
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Provider Name | RANDALL GENE RICHARD CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1415 TULANE AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2600
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Country | US
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Telephone | 504-779-5568
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 N CAUSEWAY BLVD SUITE 404
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City | METAIRIE
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State | LA
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Zip | 70002-3531
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Country | US
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Telephone | 504-779-5515
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN049958
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License Number State | LA
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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 | RN049958 AP02486
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License Number State | LA
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