Healthcare Provider Details

I. General information

NPI: 1659769149
Provider Name (Legal Business Name): LAURA ELIZABETH PETERSMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8734
US

IV. Provider business mailing address

3719 ROSEWOOD AVE
ALAMOGORDO NM
88310-8255
US

V. Phone/Fax

Practice location:
  • Phone: 727-565-6995
  • Fax:
Mailing address:
  • Phone: 727-565-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01512
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9319865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: