MEDICARE: MRS. CHERYL GUILRNILLO CRUSE LPN

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	164W00000X	Licensed Practical Nurse	790751	LA

General Provider Information

NPI Number	:	1437142767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL GUILRNILLO CRUSE LPN

Provider Business Mailing Address
First Line	:	501 RUE DE SANTE
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-5400
Country	:	US
Telephone Number	:	985-652-6700
Fax Number	:	985-651-0540

Provider Business Practice Location Address
First Line	:	501 RUE DE SANTE
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-5400
Country	:	US
Telephone Number	:	985-652-6700
Fax Number	:	985-651-0540

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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