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Individual

DUSTY COLE POURCIAU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3574
(301) 324-4968
Mailing address
7777 HENNESSY BLVD, STE 301, BATON ROUGE, LA 70808-0319
(225) 769-4403

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R230004
MD
367500000X
Certified Registered Nurse Anesthetist
RN114399
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RN114399
RN LICENSE
LA
Enumeration date
11/02/2010
Last updated
01/08/2019
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