Provider Demographics
NPI:1972729358
Name:CHARLEBOIS, DRUSCILLA D (CRNA)
Entity type:Individual
Prefix:MS
First Name:DRUSCILLA
Middle Name:D
Last Name:CHARLEBOIS
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:PO BOX 113327
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011
Mailing Address - Country:US
Mailing Address - Phone:504-309-4211
Mailing Address - Fax:504-309-4214
Practice Address - Street 1:4324 VETERANS BLVD
Practice Address - Street 2:EYE CARE ASSOCIATES
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-455-9825
Practice Address - Fax:504-455-9890
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN021043367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1391042Medicaid
LA59782Medicare ID - Type Unspecified