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General NPI Number Information
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NPI Number | 1386354777
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Entity Type | Individual
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Provider Name | JUSTIN LASURE CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 225 S CENTER AVE
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City | SOMERSET
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State | PA
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Zip | 15501-2033
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Country | US
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Telephone | 814-443-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 150
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City | MEYERSDALE
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State | PA
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Zip | 15552-0150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 98303
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN670587
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 115510
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License Number State | WV
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