Basic Information
| Provider Information | |||||||||
| NPI: | 1235225962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | PIPES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PIPES | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9050 AIRLINE HWY | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708154103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259297210 | ||||||||
| FaxNumber: | 2259307524 | ||||||||
| Practice Location | |||||||||
| Address1: | 8212 KELWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708064801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259297600 | ||||||||
| FaxNumber: | 2259307524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 058934 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1674818 | 05 | LA | MEDICAID |