Provider Demographics
NPI:1356637052
Name:TRAHAN, PRISCILLA A (CRNA)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:STE 404
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-779-5515
Mailing Address - Fax:
Practice Address - Street 1:255 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2218
Practice Address - Country:US
Practice Address - Phone:800-516-5315
Practice Address - Fax:517-787-7365
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN105022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered