Basic Information
Provider Information | |||||||||
NPI: | 1659600179 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WILLIAMS | ||||||||
FirstName: | ANNA | ||||||||
MiddleName: | HENDERSON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WILLIAMS | ||||||||
OtherFirstName: | ANNA MARIEL | ||||||||
OtherMiddleName: | HENDERSON | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 636 GAUSE BLVD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | SLIDELL | ||||||||
State: | LA | ||||||||
PostalCode: | 704582007 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9856418008 | ||||||||
FaxNumber: | 9856494063 | ||||||||
Practice Location | |||||||||
Address1: | 1700 LINDBERG DR | ||||||||
Address2: |   | ||||||||
City: | SLIDELL | ||||||||
State: | LA | ||||||||
PostalCode: | 704588062 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9856418008 | ||||||||
FaxNumber: | 9856494063 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/11/2009 | ||||||||
LastUpdateDate: | 08/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN112699 | LA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.