Individual
JODIE MARIE DUHON BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1103 KALISTE SALOOM RD, LAFAYETTE, LA 70508-5783
(337) 988-5646
Mailing address
1103 KALISTE SALOOM RD, LAFAYETTE, LA 70508-5783
(337) 988-5646
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP07321
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009936312
—
AL
05
—
307523100
—
FL
01
—
591-84925
BLUE CROSS BLUE SHIELD OF
AL
01
—
G3933
BLUE CROSS BLUE SHIELD OF
FL
Enumeration date
03/02/2006
Last updated
07/21/2022
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