Healthcare Provider Details

I. General information

NPI: 1104248228
Provider Name (Legal Business Name): ALISHA LAYMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST SUITE 407
LOUISVILLE KY
40202-1835
US

IV. Provider business mailing address

11100 HERRING CT
LOUISVILLE KY
40291-3683
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2880
  • Fax:
Mailing address:
  • Phone: 502-810-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3008529
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: