Provider Demographics
NPI:1972744746
Name:FUNDERBURK, NATALIE WRIGHT (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:WRIGHT
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 RUE DE FREJUS
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4993
Mailing Address - Country:US
Mailing Address - Phone:337-581-3290
Mailing Address - Fax:
Practice Address - Street 1:1101 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5705
Practice Address - Country:US
Practice Address - Phone:337-581-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05669367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered