Provider Demographics
NPI:1679600282
Name:CHERAMIE, CARL A (CRNA)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:CHERAMIE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 BONAIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:337-380-1822
Mailing Address - Fax:337-828-5024
Practice Address - Street 1:1097 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3407
Practice Address - Country:US
Practice Address - Phone:337-828-0760
Practice Address - Fax:337-828-5024
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN035461367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1936928Medicaid
LA1936928Medicaid