Provider Demographics
NPI:1144323726
Name:DUTY, HEATHER DIANNE (CRNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANNE
Last Name:DUTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DUTY
Other - Last Name:LEMAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:115 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2432
Mailing Address - Country:US
Mailing Address - Phone:318-343-8047
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST STE 101
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7403
Practice Address - Country:US
Practice Address - Phone:318-998-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX725913367500000X
LARN070024367500000X
TXAANA046978367500000X
LAAP02864367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1690601Medicaid
LA5X050Medicare ID - Type Unspecified