Provider Demographics
NPI:1396915948
Name:WASHINGTON, DARTAIN M (CRNA)
Entity type:Individual
Prefix:
First Name:DARTAIN
Middle Name:M
Last Name:WASHINGTON
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 1:1541 TULANE AVE
Mailing Address - Street 2:ROOM 505
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2821
Mailing Address - Country:US
Mailing Address - Phone:504-903-1301
Mailing Address - Fax:504-903-5147
Practice Address - Street 1:1532 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2860
Practice Address - Country:US
Practice Address - Phone:504-903-1301
Practice Address - Fax:504-903-5147
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103436367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered