Healthcare Provider Details

I. General information

NPI: 1083073860
Provider Name (Legal Business Name): LAUREN HARWOOD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6513
  • Fax: 606-783-6489
Mailing address:
  • Phone: 606-783-6513
  • Fax: 606-783-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3010116
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: