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General NPI Number Information
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NPI Number | 1811070717
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Entity Type | Individual
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Provider Name | ERNEST F THERIOT CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 218 CORPORATE DRIVE
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City | HOUMA
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State | LA
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Zip | 70360
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Country | US
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Telephone | 985-853-1390
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Fax | 985-853-1470
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Provider Business Mailing Address
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Address Line | 4624 HWY 24
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City | BOURG
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State | LA
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Zip | 70343
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Country | US
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Telephone | 985-594-7433
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Fax |
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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 | RN031952AP01613
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License Number State | LA
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