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NPI Code Detail

MEDICARE: MR. GERALD PEDERSEN C.R.N.A.

MEDICARE: MR. GERALD PEDERSEN C.R.N.A.
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
1367500000XCertified Registered Nurse Anesthetist23775SC
2367500000XCertified Registered Nurse Anesthetist44332LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093758716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GERALD PEDERSEN C.R.N.A.
Provider Business Mailing Address
First Line : 3617 HYACINTH AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-2933
Country : US
Telephone Number : 225-389-2928
Fax Number : 225-389-2931
Provider Business Practice Location Address
First Line : 6300 MAIN ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-4037
Country : US
Telephone Number : 225-658-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 05/19/2024

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