Healthcare Provider Details

I. General information

NPI: 1265601884
Provider Name (Legal Business Name): CREFASI ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 SHADOW LAKE DR
BATON ROUGE LA
70816-3795
US

IV. Provider business mailing address

3145 SHADOW LAKE DR
BATON ROUGE LA
70816-3795
US

V. Phone/Fax

Practice location:
  • Phone: 223-753-4805
  • Fax: 866-635-0474
Mailing address:
  • Phone: 223-753-4805
  • Fax: 866-635-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number71419
License Number StateLA

VIII. Authorized Official

Name: MR. NICHOLAS A CREFASI
Title or Position: PRESIDENT
Credential:
Phone: 225-753-4805