Individual
MR. DANE MATTHEW RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
6300 MAIN ST, ZACHARY, LA 70791-4037
(225) 658-4337
(225) 658-4181
Mailing address
8946 INTERLINE AVE, SUITE C, BATON ROUGE, LA 70809-1913
(225) 923-0030
(225) 923-0060
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
121003
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
1210036736
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07674505
—
MS
05
—
2182081
—
LA
Enumeration date
12/15/2011
Last updated
03/12/2015
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