Basic Information
| Provider Information | |||||||||
| NPI: | 1548493281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SHANE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62600 DEPT 1491 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701622600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002421131 | ||||||||
| FaxNumber: | 5177877107 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 N CAUSEWAY BLVD | ||||||||
| Address2: | 404 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700023531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047795515 | ||||||||
| FaxNumber: | 5047795568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2009 | ||||||||
| LastUpdateDate: | 08/28/2009 | ||||||||
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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 | AP05846 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.