Provider Demographics
NPI:1851531057
Name:TRAHAN, DUSTIN K (CRNA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:K
Last Name:TRAHAN
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-214-6436
Mailing Address - Fax:225-214-6437
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-214-6436
Practice Address - Fax:225-214-6437
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL081948367500000X
LAAP05693367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX767213OtherTEXAS LICENSE
LA2130048Medicaid
LA311809YJJZMedicare PIN