Individual
VICKY L VILCAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 493-4750
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 493-4750
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
099144
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477168
—
LA
Enumeration date
11/09/2006
Last updated
02/06/2012
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