Provider Demographics
NPI:1801849625
Name:AGE, VERNA SHERMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:SHERMAN
Last Name:AGE
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 1:9290 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2200
Mailing Address - Country:US
Mailing Address - Phone:504-241-7995
Mailing Address - Fax:985-649-4908
Practice Address - Street 1:58305 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-3814
Practice Address - Country:US
Practice Address - Phone:504-908-6306
Practice Address - Fax:985-649-4908
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109231367500000X
LARN041635-AP12621367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
611077369 1295716850OtherHEALTHNET
000000671115OtherANTHEM
OH3075890Medicaid
KY74012469Medicaid
IN200992140Medicaid
P00857348Medicare PIN
P400023185Medicare PIN