Basic Information
| Provider Information | |||||||||
| NPI: | 1154553501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUEDRY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13523 BARRETT PARKWAY DRIVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630213802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369386868 | ||||||||
| FaxNumber: | 6369381486 | ||||||||
| Practice Location | |||||||||
| Address1: | 7145 PERKINS ROAD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257653111 | ||||||||
| FaxNumber: | 2257653114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2009 | ||||||||
| LastUpdateDate: | 08/03/2010 | ||||||||
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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 | RN104056 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | RN-104056-AP05841 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.