Provider Demographics
NPI:1952508897
Name:COLOMER, MARY E (CRNA, MN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COLOMER
Suffix:
Gender:F
Credentials:CRNA, MN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:SCHAMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-0612
Practice Address - Fax:918-481-5170
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200783367500000X
LARN100017367500000X
LAAP05425367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03576769Medicaid
LA1012912Medicaid
LA3A3327061Medicare PIN
MS03576769Medicaid