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NPI Code Detail

MEDICARE: MRS. GLENDA POCHE VICKNAIR CRNA

MEDICARE: MRS. GLENDA POCHE VICKNAIR 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
1163W00000XRegistered NurseRN027658LA
2367500000XCertified Registered Nurse Anesthetist021000LA

General Provider Information

NPI Number : 1588646160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLENDA POCHE VICKNAIR CRNA
Provider Business Mailing Address
First Line : 316 N MILLET AVE
Second Line :
City : GRAMERCY
State : LA
Zip : 70052-3610
Country : US
Telephone Number : 225-869-8668
Fax Number :
Provider Business Practice Location Address
First Line : 2471 LOUISIANA AVE
Second Line : ST JAMES PARISH HOSPITAL
City : LUTCHER
State : LA
Zip : 70071-5413
Country : US
Telephone Number : 225-869-5512
Fax Number : 225-869-4956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 09/11/2025

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