Provider Demographics
NPI:1316952831
Name:LOUZADER, SAMUELA G (CRNA)
Entity type:Individual
Prefix:
First Name:SAMUELA
Middle Name:G
Last Name:LOUZADER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 W OAKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1687
Mailing Address - Country:US
Mailing Address - Phone:417-888-0428
Mailing Address - Fax:
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4268
Practice Address - Country:US
Practice Address - Phone:417-447-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO047013367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918243312Medicaid
MO918243312Medicaid