Individual
STACY R EMBANATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
323 W. WALNUT AVENUE, BASTROP, LA 71220
(318) 343-2200
Mailing address
255 W MICHIGAN AVE, P O BOX 1123, JACKSON, MI 49201-2218
(517) 787-6440
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP04193
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1153893
—
LA
Enumeration date
11/01/2006
Last updated
02/04/2014
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