Basic Information
| Provider Information | |||||||||
| NPI: | 1699749887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAIGLE | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6037 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703616037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858734235 | ||||||||
| FaxNumber: | 9858514307 | ||||||||
| Practice Location | |||||||||
| Address1: | 8166 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858734141 | ||||||||
| FaxNumber: | 9858514307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 088379-03815 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1108049 | 05 | LA | MEDICAID |