Provider Demographics
NPI:1073149225
Name:RICKERT, CAROLINE ZELENKA (CRNA, RN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ZELENKA
Last Name:RICKERT
Suffix:
Gender:F
Credentials:CRNA, RN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:MARGARET
Other - Last Name:ZELENKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:420 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5724
Mailing Address - Country:US
Mailing Address - Phone:985-502-6477
Mailing Address - Fax:
Practice Address - Street 1:2000 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3018
Practice Address - Country:US
Practice Address - Phone:504-702-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA225898367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program