Healthcare Provider Details

I. General information

NPI: 1750332391
Provider Name (Legal Business Name): JEREMY JOSEPH BOYER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 AMBERGRIS LN
LAFAYETTE LA
70508-8152
US

IV. Provider business mailing address

305 AMBERGRIS LN
LAFAYETTE LA
70508-8152
US

V. Phone/Fax

Practice location:
  • Phone: 337-280-9311
  • Fax:
Mailing address:
  • Phone: 337-280-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN105054
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04848
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: