Healthcare Provider Details

I. General information

NPI: 1558656918
Provider Name (Legal Business Name): CHRISTOPHER WAYNE CHAISSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N ACADIA RD
THIBODAUX LA
70301-4847
US

IV. Provider business mailing address

PO BOX 5478
THIBODAUX LA
70302-5478
US

V. Phone/Fax

Practice location:
  • Phone: 985-493-4511
  • Fax:
Mailing address:
  • Phone: 985-493-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN113308
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number139606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: