Individual
KENNETH JOSEPH WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3000
Mailing address
2305 PINEWOOD DR S, LAKE CHARLES, LA 70607-7522
(337) 764-5751
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
234093
LA
Other
Enumeration date
02/12/2024
Last updated
02/24/2024
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