Healthcare Provider Details

I. General information

NPI: 1255337085
Provider Name (Legal Business Name): DONALD JAMES STAFFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CABRINI HOSPITAL ANESTHESIA DEPT 3330 MASONIC DRIVE
ALEXANDRIA LA
71301
US

IV. Provider business mailing address

PO BOX 4731
PINEVILLE LA
71361-4731
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-6790
  • Fax:
Mailing address:
  • Phone: 318-641-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01528
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP01558
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number665182
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number68582-1558
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: