Provider Demographics
NPI:1346448420
Name:PREVOST, SHOLA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:SHOLA
Middle Name:MICHELLE
Last Name:PREVOST
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHOLA
Other - Middle Name:MICHELLE
Other - Last Name:PREVOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3901 N. I-10 SERVICE RD. APT. F 147
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-722-3826
Mailing Address - Fax:
Practice Address - Street 1:3901 N. I-10 SERVICE RD. APT. F 147
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-722-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA094850367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered