Individual
MR. BRANDON HEATH FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4150 NELSON RD, A4, LAKE CHARLES, LA 70605
(337) 474-6353
(337) 477-7616
Mailing address
4150 NELSON RD, A4, LAKE CHARLES, LA 70605
(337) 474-6353
(337) 477-7616
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
AP04635
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN100667
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478911
—
LA
Enumeration date
02/12/2007
Last updated
11/04/2008
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