Provider Demographics
NPI:1518931229
Name:MAPP, EDMON LISTON JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EDMON
Middle Name:LISTON
Last Name:MAPP
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:163 BOONER MILLER RD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9445
Mailing Address - Country:US
Mailing Address - Phone:318-443-1700
Mailing Address - Fax:318-443-1703
Practice Address - Street 1:163 BOONER MILLER RD
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328-9445
Practice Address - Country:US
Practice Address - Phone:318-443-1700
Practice Address - Fax:318-443-1703
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA40557367500000X
TX704026367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered