Individual
MARY ALDEN FONTENOT
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
(337) 988-5646
Mailing address
1103 KALISTE SALOOM RD., SUITE 304, LAFAYETTE, LA 70508
(337) 988-5646
(517) 787-7365
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
849661
TX
Other
Enumeration date
03/03/2014
Last updated
05/12/2016
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