Individual
THERESA BOURG VICKNAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
ST JAMES PARISH HOSIPITAL, LOUISIANE AVE, LUTCHER, LA 70071
(225) 869-5512
Mailing address
124 JENNIFER LN, LA PLACE, LA 70068-5806
(985) 359-0599
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN059871
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP01519
LA
Other
Enumeration date
11/10/2005
Last updated
09/11/2025
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