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General NPI Number Information
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NPI Number | 1609500248
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Entity Type | Individual
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Provider Name | LAUREN KATELYN FERM CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 221 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61636-0001
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Country | US
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Telephone | 309-672-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 KENSINGTON PL
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6472
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Country | US
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Telephone | 815-931-3103
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | XXXXXXX
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License Number State | NC
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