Healthcare Provider Details

I. General information

NPI: 1477026367
Provider Name (Legal Business Name): LAUREN ROBERTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 USA MEDICAL CENTER DR
MOBILE AL
36617-2300
US

IV. Provider business mailing address

28 STONES THROW DR
HATTIESBURG MS
39402-9021
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number122184
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: