Healthcare Provider Details

I. General information

NPI: 1568560407
Provider Name (Legal Business Name): ROLAND OGOMWEN OKUNGBOWA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 PERKINS ROAD
BATON ROUGE LA
70808-4322
US

IV. Provider business mailing address

7145 PERKINS ROAD
BATON ROUGE LA
70808-4322
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-3111
  • Fax: 225-765-3114
Mailing address:
  • Phone: 225-765-3111
  • Fax: 225-765-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04753
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number37502
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-096621-AP04753
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: