Healthcare Provider Details

I. General information

NPI: 1225174782
Provider Name (Legal Business Name): LAURIA LYNDA MASON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD ANESTHESIOLOGY
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

8814 E SUNNYSIDE DR
SCOTTSDALE AZ
85260-8622
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-0641
  • Fax: 928-692-2741
Mailing address:
  • Phone: 702-525-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN034358
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: