Individual
CHERYL D. BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
310 N. CAUSEWAY, SUITE 404, METAIRIE, LA 70002
(504) 779-5515
(504) 454-7486
Mailing address
257 BROCKENBRAUGH CT., METAIRIE, LA 70005
(504) 289-1594
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP03130
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1694991
—
LA
01
—
P00397040
RAILROAD MEDICARE
GA
Enumeration date
12/01/2005
Last updated
12/14/2010
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