Provider Demographics
NPI:1932351558
Name:ELLIS, GERRI THOMAS (CRNA)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:THOMAS
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:RENEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3185
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3185
Mailing Address - Country:US
Mailing Address - Phone:318-998-6129
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:STE 101
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-998-6129
Practice Address - Fax:318-998-6139
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN055481367500000X
PARN599680367500000X
TX767677367500000X
LAAP05725367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00928955OtherRAILROAD
LA2177630Medicaid
TX209429402Medicaid
TX8852UAOtherBCBS
LA2177630Medicaid
TX209429402Medicaid