MEDICARE: CLAIRE AUBUCHON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	14360	MO

General Provider Information

NPI Number	:	1003812884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE AUBUCHON CRNA

Provider Business Mailing Address
First Line	:	120 BREEZEVIEW DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-5020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 N BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3404
Country	:	US
Telephone Number	:	314-996-5330
Fax Number	:	314-810-1399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	07/09/2007

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