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1356379325
RANDY PROVENSAL
METAIRIE, LA
NPI
1356379325
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: LA RN034091)
Enumeration Date
2006-06-29
Last Update Date
2023-09-06
Business Address
RANDY PROVENSAL CRNA
3510 N CAUSEWAY BLVD
METAIRIE, LA 70002-3531
Phone number: 504-779-5568
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Mailing Address
RANDY PROVENSAL CRNA
744 W MICHIGAN AVE
JACKSON, MI 49201-1909
Phone number: 517-787-6440
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