MEDICARE: DARRYL MARK LODATO APRN-CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN040232	LA
2	367500000X	Certified Registered Nurse Anesthetist	40232-1818 CERT.	LA

General Provider Information

NPI Number	:	1932143260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL MARK LODATO APRN-CRNA

Provider Business Mailing Address
First Line	:	235 SAINT ANN DR
Second Line	:	SUITE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3396
Country	:	US
Telephone Number	:	985-727-7275
Fax Number	:	985-727-7915

Provider Business Practice Location Address
First Line	:	235 SAINT ANN DR
Second Line	:	SUITE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3396
Country	:	US
Telephone Number	:	985-727-7275
Fax Number	:	985-727-7915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/12/2010

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