Provider Demographics
NPI:1316973837
Name:CROSBY, NAM SOOK (CRNA)
Entity type:Individual
Prefix:
First Name:NAM
Middle Name:SOOK
Last Name:CROSBY
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 1:11965 HOMEPORT DR
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-3041
Mailing Address - Country:US
Mailing Address - Phone:225-247-2862
Mailing Address - Fax:
Practice Address - Street 1:2021 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-903-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN065562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559105Medicaid
LA5CH27Medicare PIN