Healthcare Provider Details

I. General information

NPI: 1023004645
Provider Name (Legal Business Name): JANET LAUGHLIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6485 POPLAR AVE
MEMPHIS TN
38119-4838
US

IV. Provider business mailing address

359 WELLINGTON CV
JACKSON TN
38305-6609
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-4014
  • Fax:
Mailing address:
  • Phone: 731-664-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN0000044459
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: