Healthcare Provider Details

I. General information

NPI: 1982257283
Provider Name (Legal Business Name): THU T DANG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 S CLEARVIEW PKWY APT 257
RIVER RIDGE LA
70123-6342
US

IV. Provider business mailing address

838 S CLEARVIEW PKWY APT 257
RIVER RIDGE LA
70123-6342
US

V. Phone/Fax

Practice location:
  • Phone: 469-237-0881
  • Fax:
Mailing address:
  • Phone: 469-237-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number207253
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: