Provider Demographics
NPI:1689688749
Name:SOILEAU, ROBBIE J (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:J
Last Name:SOILEAU
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 1:12685 LILLY LN
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9548
Mailing Address - Country:US
Mailing Address - Phone:318-466-9169
Mailing Address - Fax:318-757-7847
Practice Address - Street 1:241 AIMEE RD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-9615
Practice Address - Country:US
Practice Address - Phone:318-757-6371
Practice Address - Fax:318-757-7847
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04360367500000X
MSR874174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1177431Medicaid
LA1177431Medicaid
LA4C921Medicare ID - Type UnspecifiedLA MEDICARE