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General NPI Number Information
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NPI Number | 1295073781
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Entity Type | Individual
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Provider Name | JUSTIN M VERMEULEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 8212 SUMMA AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3421
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Country | US
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Telephone | 225-769-4403
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3016642
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License Number State | KY
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