Provider Demographics
NPI:1467486936
Name:FONTENOT, WILLIAM DEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14447
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4447
Mailing Address - Country:US
Mailing Address - Phone:225-923-0030
Mailing Address - Fax:225-923-0060
Practice Address - Street 1:1634 ELTON RD
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3614
Practice Address - Country:US
Practice Address - Phone:225-923-0030
Practice Address - Fax:225-923-0060
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38458367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1903868Medicaid
LA1903868Medicaid
LA59728CV47Medicare PIN