Provider Demographics
NPI:1447395637
Name:ALEXANDER, CAROLYN M (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:ALEXANDER
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:PO BOX 53847
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3847
Mailing Address - Country:US
Mailing Address - Phone:337-706-1500
Mailing Address - Fax:337-988-3059
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-706-1500
Practice Address - Fax:337-988-3059
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05109367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1408433Medicaid
LA3A120Medicare PIN