Basic Information
| Provider Information | |||||||||
| NPI: | 1538438981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARDOIN | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 US 190 | ||||||||
| Address2: | |||||||||
| City: | EUNICE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3378310562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1103 KALISTE SALOOM RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705085783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379885646 | ||||||||
| FaxNumber: | 3379884298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 100596 | LA | N | Nursing Service Providers | Registered Nurse | 367500000X | AP06743 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.