Individual
TATE FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 S PINE ST, DERIDDER, LA 70634-4942
(337) 401-5253
Mailing address
1009 SHERRY LN, DERIDDER, LA 70634-8976
(337) 401-5253
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
234088
LA
Other
Enumeration date
01/08/2024
Last updated
01/08/2024
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