Healthcare Provider Details

I. General information

NPI: 1376898510
Provider Name (Legal Business Name): JUDE JULIEN FORET CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 INDUSTRIAL BLVD
HOUMA LA
70363-7055
US

IV. Provider business mailing address

1114 BELMERE LUXURY CT
HOUMA LA
70360-2969
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-1814
  • Fax:
Mailing address:
  • Phone: 985-414-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06898
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: