Provider Demographics
NPI:1306816525
Name:GISCLAIR, RODNEY JOSEPH JR (CRNA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JOSEPH
Last Name:GISCLAIR
Suffix:JR
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 1:138 J -7 RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394
Mailing Address - Country:US
Mailing Address - Phone:985-532-6460
Mailing Address - Fax:985-537-8282
Practice Address - Street 1:123 FRONTAGE A RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6301
Practice Address - Country:US
Practice Address - Phone:985-580-1200
Practice Address - Fax:985-580-1218
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN079326367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1721433Medicaid
MS06970503OtherMS CAID
4H562D885Medicare ID - Type Unspecified
LA320205YH3UMedicare PIN