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NPI Code Detail

MEDICARE: MS. ANNIE LAURIE BALTHAZAR CRNA

MEDICARE: MS. ANNIE LAURIE BALTHAZAR 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
1367500000XCertified Registered Nurse Anesthetist76411WV

General Provider Information

NPI Number : 1487635918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNIE LAURIE BALTHAZAR CRNA
Provider Business Mailing Address
First Line : 2655 NORTHWINDS PKWY
Second Line :
City : ALPHARETTA
State : GA
Zip : 30009-2280
Country : US
Telephone Number : 530-902-9740
Fax Number :
Provider Business Practice Location Address
First Line : 2655 NORTHWINDS PKWY
Second Line :
City : ALPHARETTA
State : GA
Zip : 30009-2280
Country : US
Telephone Number : 530-902-9740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 01/15/2016

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