Provider Demographics
NPI:1417148511
Name:O'TOOLE, ANITA MICHELLE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MICHELLE
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:MICHELLE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4864 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6400
Mailing Address - Country:US
Mailing Address - Phone:318-330-7858
Mailing Address - Fax:318-330-7719
Practice Address - Street 1:4864 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-330-7858
Practice Address - Fax:318-330-7719
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05132367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered