Provider Demographics
NPI:1699866459
Name:HARRELL, LOUISE (CRNA)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:HARRELL
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 1:3050 E AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2404
Mailing Address - Country:US
Mailing Address - Phone:562-426-9661
Mailing Address - Fax:562-426-4227
Practice Address - Street 1:165 W HOSPITALITY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3334
Practice Address - Country:US
Practice Address - Phone:909-885-0282
Practice Address - Fax:909-889-7367
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1486367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN3460130OtherMEDI-CAL
CAP00953545Medicare PIN
CARN3460130OtherMEDI-CAL