Provider Demographics
NPI:1780980672
Name:SEWELL, GAYLE BELLANGER (CRNA)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:BELLANGER
Last Name:SEWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:ANN
Other - Last Name:BELLANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3510 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3531
Practice Address - Country:US
Practice Address - Phone:504-779-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered