Provider Demographics
NPI:1659583219
Name:GAUTREAU, CHRISTIE L (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:L
Last Name:GAUTREAU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:L
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:225-761-5200
Mailing Address - Fax:225-726-2091
Practice Address - Street 1:10310 THE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70836-6455
Practice Address - Country:US
Practice Address - Phone:225-761-5200
Practice Address - Fax:225-726-2091
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN101325 AP04895367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN101325 AP04895OtherADVANCE PRAC LIC