Individual
MICHELLE H MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2429
(866) 624-7637
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3755
(504) 842-2036
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
213764
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2020
Last updated
09/10/2020
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