Provider Demographics
NPI:1588646160
Name:VICKNAIR, GLENDA POCHE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:POCHE
Last Name:VICKNAIR
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 1:316 N MILLET AVE
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3610
Mailing Address - Country:US
Mailing Address - Phone:225-869-8668
Mailing Address - Fax:
Practice Address - Street 1:2471 LOUISIANA AVE
Practice Address - Street 2:ST JAMES PARISH HOSPITAL
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5413
Practice Address - Country:US
Practice Address - Phone:225-869-5512
Practice Address - Fax:225-869-4956
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN027658163W00000X
LA021000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered