Individual
MS. WANDA C DEFRAITES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 765-8843
Mailing address
4300 FOLSE DR, METAIRIE, LA 70006-1225
(504) 887-8859
(504) 887-8859
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
05765401886
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP01886
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1904783
—
LA
Enumeration date
11/01/2006
Last updated
12/30/2024
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