Individual
DAMON FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 730-6700
(985) 730-6713
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5727
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN073334
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1107042
—
LA
Enumeration date
05/30/2005
Last updated
12/30/2020
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