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General NPI Number Information
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NPI Number | 1154690436
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Entity Type | Individual
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Provider Name | DANE MATTHEW RODRIGUEZ C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 6300 MAIN ST
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City | ZACHARY
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State | LA
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Zip | 70791-4037
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Country | US
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Telephone | 225-658-4337
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Fax | 225-658-4181
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Provider Business Mailing Address
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Address Line | 8946 INTERLINE AVE SUITE C
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City | BATON ROUGE
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State | LA
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Zip | 70809-1913
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Country | US
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Telephone | 225-923-0030
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Fax | 225-923-0060
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 121003
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1210036736
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License Number State | LA
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