Basic Information
| Provider Information | |||||||||
| NPI: | 1396759833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRET | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704615520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856497070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704615520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855074743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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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 | APO4961 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | APO4961 | 01 | LA | CRNA | OTHER | RN104246 | 01 | LA | RN LICENSE | OTHER | 01273306 | 05 | MS | MEDICAID | 1583031 | 05 | LA | MEDICAID |