Individual
GREGORY RABALAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1015 UNITY RD, HWY 82E, CROSSETT, AR 71635-9443
(870) 364-1280
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R63088
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136838701
—
AR
01
—
5U361
BLUE CROSS OF AR
AR
Enumeration date
04/19/2006
Last updated
04/29/2008
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