Individual
MARY Q PASSOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1103 KALISTE SALOOM RD, SUITE 304, LAFAYETTE, LA 70508-5783
(337) 988-5646
(337) 988-4298
Mailing address
1103 KALISTE SALOOM RD, SUITE 304, LAFAYETTE, LA 70508-5783
(337) 988-5646
(337) 988-4298
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN099257
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1408549
—
LA
Enumeration date
02/12/2007
Last updated
08/02/2010
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