Provider Demographics
NPI:1982991360
Name:BROWN, LATERRICA A (CRNA)
Entity Type:Individual
Prefix:
First Name:LATERRICA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LATERRICA
Other - Middle Name:D
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5845 COLBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2801
Mailing Address - Country:US
Mailing Address - Phone:225-939-4693
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE S450
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6401
Practice Address - Fax:504-349-6444
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN116256163W00000X
LAAP06489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2161377Medicaid