1396770228 NPI number — MS. TARA TRAPANI INGRAHAM CRNA

Table of content: MS. TARA TRAPANI INGRAHAM CRNA (NPI 1396770228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396770228 NPI number — MS. TARA TRAPANI INGRAHAM CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGRAHAM
Provider First Name:
TARA
Provider Middle Name:
TRAPANI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396770228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719 SWEET BAY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-427-4693
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4407 HWY 190 SERVICE ROAD EAST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-234-9700
Provider Business Practice Location Address Fax Number:
985-234-9706
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  050308 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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