Basic Information
| Provider Information | |||||||||
| NPI: | 1154374437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINKOZIE | ||||||||
| FirstName: | DENNIS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 BERKLEY AVE | ||||||||
| Address2: | |||||||||
| City: | HARAHAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701234601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047373120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1415 TULANE AVE | ||||||||
| Address2: | HC 71 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 129053 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | AP04830 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 06770589 | 05 | MS | MEDICAID | 1009822 | 05 | LA | MEDICAID | P00413430 | 01 | LA | RR MEDICARE | OTHER | 0640579 | 05 | OH | MEDICAID |