Provider Demographics
NPI:1760426811
Name:WESTBROOK, PHILLIP DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DAVID
Last Name:WESTBROOK
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 1:112 FRONT AVE-CALVIN
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-7776
Mailing Address - Country:US
Mailing Address - Phone:318-727-9298
Mailing Address - Fax:
Practice Address - Street 1:112 FRONT AVE
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-7776
Practice Address - Country:US
Practice Address - Phone:318-727-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN036870/AP01396367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006H71OtherBCBS
NM70805253Medicaid
NM70805253Medicaid