Basic Information
| Provider Information | |||||||||
| NPI: | 1972781656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASSEIGNE | ||||||||
| FirstName: | CHAZ | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9260 W SUNSET RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891484858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022553547 | ||||||||
| FaxNumber: | 7029212419 | ||||||||
| Practice Location | |||||||||
| Address1: | 9260 W SUNSET RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891484858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022553547 | ||||||||
| FaxNumber: | 7029212419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/24/2020 | ||||||||
| NPIReactivationDate: | 06/01/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 749187 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | CRNA000467 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1983322-01 | 05 | TX | MEDICAID | 89640U | 01 | TX | BCBS | OTHER |