| NPI | 1003458704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL THIBODEAUX President 319-331-0621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-14 |