Healthcare Provider Details

I. General information

NPI: 1689810392
Provider Name (Legal Business Name): LAURA BERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

PO BOX 70
LAKE FOREST IL
60045-0070
US

V. Phone/Fax

Practice location:
  • Phone: 480-515-6296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041318919
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number302111
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: