Healthcare Provider Details

I. General information

NPI: 1184658361
Provider Name (Legal Business Name): DAUTERIVE PROFESSIONALS MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N LEWIS ST
NEW IBERIA LA
70563-2043
US

IV. Provider business mailing address

PO BOX 53533
LAFAYETTE LA
70505-3533
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-3168
  • Fax:
Mailing address:
  • Phone: 337-365-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE BOUDREAUX
Title or Position: CFO
Credential:
Phone: 337-365-2812