Provider Demographics
NPI:1467782193
Name:FUSSELL, HOWARD MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:MICHAEL
Last Name:FUSSELL
Suffix:
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 1:740 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2845
Mailing Address - Country:US
Mailing Address - Phone:985-789-0272
Mailing Address - Fax:
Practice Address - Street 1:4700 S I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1269
Practice Address - Country:US
Practice Address - Phone:504-988-5903
Practice Address - Fax:504-988-1941
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered