Provider Demographics
NPI:1780852327
Name:POCHE, ANNETTE P (CST)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:P
Last Name:POCHE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WESTBANK EXPY STE 7
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5644
Mailing Address - Country:US
Mailing Address - Phone:504-366-7233
Mailing Address - Fax:504-362-5529
Practice Address - Street 1:515 WESTBANK EXPY STE 7
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5644
Practice Address - Country:US
Practice Address - Phone:504-366-7233
Practice Address - Fax:504-362-5529
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA074240246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA074240OtherCERTIFICATE #