1801849625 NPI number — VERNA SHERMAN AGE CRNA

Table of content: VERNA SHERMAN AGE CRNA (NPI 1801849625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801849625 NPI number — VERNA SHERMAN AGE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGE
Provider First Name:
VERNA
Provider Middle Name:
SHERMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801849625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9290 MORRISON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70127-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-241-7995
Provider Business Mailing Address Fax Number:
985-649-4908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58305 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70460-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-908-6306
Provider Business Practice Location Address Fax Number:
985-649-4908
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  1109231 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RN041635-AP12621 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 611077369 1295716850 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000671115 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3075890 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74012469 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200992140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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