Individual
SANDRA D LISOTTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8212 SUMMA AVE, BATON ROUGE, LA 70809
(225) 769-4403
(225) 769-4403
Mailing address
8212 SUMMA AVE, GONZALES, LA 70737
(225) 769-4403
(225) 769-4403
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
039091 02465
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039091 02465
LA CRNA LIC
LA
Enumeration date
08/22/2007
Last updated
08/22/2007
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