Healthcare Provider Details

I. General information

NPI: 1487628038
Provider Name (Legal Business Name): DAVID J GUIDRY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 2ND AVE
LATROBE PA
15650-1068
US

IV. Provider business mailing address

PO BOX 229
LATROBE PA
15650-0229
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1230
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN358228L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: