Provider Demographics
NPI:1194989111
Name:DI BUONO, TARA L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:DI BUONO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:K
Other - Last Name:LAPEZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 450
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3155
Mailing Address - Country:US
Mailing Address - Phone:504-834-2062
Mailing Address - Fax:504-831-7429
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-468-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306525Medicaid
MS05035526Medicaid
LA3A803CT29Medicare PIN
P00703026Medicare PIN