Provider Demographics
NPI:1629280763
Name:HUNTER, SYNETHIA SELLS (CRNA)
Entity Type:Individual
Prefix:
First Name:SYNETHIA
Middle Name:SELLS
Last Name:HUNTER
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:P.O. BOX 1520
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1520
Mailing Address - Country:US
Mailing Address - Phone:504-349-6401
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD.
Practice Address - Street 2:SUITE S-450
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6401
Practice Address - Fax:504-349-6444
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA105366367500000X
LARN105366367500000X
LAAP05220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024015Medicaid
LA1024015Medicaid