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General NPI Number Information
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NPI Number | 1184658361
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Entity Type | Organization
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Legal Business Name | DAUTERIVE PROFESSIONALS MANAGEMENT
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 600 N LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2043
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Country | US
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Telephone | 337-365-3168
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 53533
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City | LAFAYETTE
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State | LA
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Zip | 70505-3533
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Country | US
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Telephone | 337-365-3168
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. STEPHANIE BOUDREAUX
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Credential |
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Telephone | 337-365-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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