Fortenberry, Damon

Fortenberry, Damon is an individual health care provider with primary practice located at 433 Plaza St , Bogalusa LA 70427-3729. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Fortenberry, Damon can be contacted via phone (985) 730-6700.

Contact Information

Primary practice address
433 Plaza St Bogalusa LA 70427-3729
Phone: (985) 730-6700
Fax: (985) 730-6713
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RN073334 Louisiana

Profile Details

NPI number 1790788214
LBN Legal business name Fortenberry, Damon
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2005
Last updated Dec 30th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790788214 NPPES
Louisiana MEDICAID 1107042

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