1831153857 NPI number — JANE JARRELL CARDINALE CRNA

Table of content: JANE JARRELL CARDINALE CRNA (NPI 1831153857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831153857 NPI number — JANE JARRELL CARDINALE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDINALE
Provider First Name:
JANE
Provider Middle Name:
JARRELL
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:
JARRELL
Provider Other First Name:
JANE
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831153857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70404-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-230-6685
Provider Business Mailing Address Fax Number:
985-230-2173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15790 PAUL VEGA MD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-230-1682
Provider Business Practice Location Address Fax Number:
985-230-1617
Provider Enumeration Date:
04/14/2006

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:  AP04023 , 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: 1121975 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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