Provider Demographics
NPI:1932143260
Name:LODATO, DARRYL MARK (APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:MARK
Last Name:LODATO
Suffix:
Gender:M
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SAINT ANN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3396
Mailing Address - Country:US
Mailing Address - Phone:985-727-7275
Mailing Address - Fax:985-727-7915
Practice Address - Street 1:235 SAINT ANN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3396
Practice Address - Country:US
Practice Address - Phone:985-727-7275
Practice Address - Fax:985-727-7915
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN040232367500000X
LA40232-1818 CERT.367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered