Provider Demographics
NPI:1699766493
Name:DUPRE, NEAL ANTHONY (CRNA)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:ANTHONY
Last Name:DUPRE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:NEAL
Other - Middle Name:ANTHONY
Other - Last Name:DUPRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:500 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3315
Mailing Address - Country:US
Mailing Address - Phone:337-896-9639
Mailing Address - Fax:
Practice Address - Street 1:105 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5372
Practice Address - Country:US
Practice Address - Phone:337-896-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN043495 AP01447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8068UNOtherBCBS