Healthcare Provider Details

I. General information

NPI: 1477637338
Provider Name (Legal Business Name): JACOB P LAUNEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

IV. Provider business mailing address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-5261
  • Fax: 337-468-3342
Mailing address:
  • Phone: 337-468-5261
  • Fax: 337-468-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04886
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: