Healthcare Provider Details

I. General information

NPI: 1407822802
Provider Name (Legal Business Name): LAURA I TROVATI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94220 4TH ST
GOLD BEACH OR
97444-7756
US

IV. Provider business mailing address

94220 4TH ST
GOLD BEACH OR
97444-7756
US

V. Phone/Fax

Practice location:
  • Phone: 541-247-3000
  • Fax: 541-247-3151
Mailing address:
  • Phone: 541-247-3000
  • Fax: 541-247-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number27242
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200860047CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: