Basic Information
| Provider Information | |||||||||
| NPI: | 1003170812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMBRE | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62600 DEPT 1362 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701622600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779881890 | ||||||||
| FaxNumber: | 3372375102 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 W ESPLANADE AVE | ||||||||
| Address2: | |||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044688600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 115959 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2304704 | 05 | LA | MEDICAID | 04304065 | 05 | MS | MEDICAID |