Individual
GAGE DUET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 447-5500
Mailing address
113 ADAMS ST, THIBODAUX, LA 70301-6836
(985) 291-1204
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
213266
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2020
Last updated
08/07/2021
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