Provider Demographics
NPI:1720589690
Name:BILBO, JOEL ELDON (CRNA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ELDON
Last Name:BILBO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 INNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9123
Mailing Address - Country:US
Mailing Address - Phone:985-892-3225
Mailing Address - Fax:985-234-0628
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-649-8767
Practice Address - Fax:985-649-8838
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP09731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered