Provider Demographics
NPI:1861792681
Name:TRAHAN, DANA CLARK (CRNA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:CLARK
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0319
Mailing Address - Country:US
Mailing Address - Phone:985-859-2937
Mailing Address - Fax:
Practice Address - Street 1:8212 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3421
Practice Address - Country:US
Practice Address - Phone:225-769-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA076760163W00000X
LAAP06415367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse