Healthcare Provider Details

I. General information

NPI: 1144592775
Provider Name (Legal Business Name): SAMANTHA CORMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

102 PLAINVIEW DR
LAFAYETTE LA
70508-6304
US

V. Phone/Fax

Practice location:
  • Phone: 985-285-3582
  • Fax:
Mailing address:
  • Phone: 337-322-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06741
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: