Provider Demographics
NPI:1790016970
Name:VANDERHOEVEN, JOHANNA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LEE
Last Name:VANDERHOEVEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5887
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-5887
Mailing Address - Country:US
Mailing Address - Phone:318-442-5399
Mailing Address - Fax:318-442-1586
Practice Address - Street 1:1444 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3432
Practice Address - Country:US
Practice Address - Phone:318-442-5399
Practice Address - Fax:318-442-1586
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered