Provider Demographics
NPI:1043264864
Name:ANDERSON, WARREN JEFFREY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:JEFFREY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1909
Mailing Address - Country:US
Mailing Address - Phone:517-787-6440
Mailing Address - Fax:517-787-4146
Practice Address - Street 1:3150 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4810
Practice Address - Country:US
Practice Address - Phone:504-779-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRN080277174400000X
LAAP04032367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1153427Medicaid
LAP00399837OtherRAILROAD MEDICARE
LAP00399837OtherRAILROAD MEDICARE