Individual
RANDALL E WISENOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
203 BAYSIDE DR, WEST MONROE, LA 71291-8696
(318) 396-1379
Mailing address
203 BAYSIDE DR, WEST MONROE, LA 71291-8696
(318) 396-1379
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN070478
LA
367500000X
Certified Registered Nurse Anesthetist
APO2815
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1673749
—
LA
Enumeration date
07/07/2006
Last updated
02/15/2008
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