Individual
BRENT E INGVARDSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5581
Mailing address
511 DIXIE SWIM CLUB RD, STONEWALL, LA 71078-9538
(318) 933-8201
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP04397
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478407
—
LA
Enumeration date
09/20/2006
Last updated
07/08/2007
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