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General NPI Number Information
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NPI Number | 1609812205
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Entity Type | Individual
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Provider Name | LAURA MAE LEE CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 60 HOSPITAL RD
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City | NEWNAN
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State | GA
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Zip | 30263-1210
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Country | US
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Telephone | 269-369-5639
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Fax |
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Provider Business Mailing Address
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Address Line | 20 DEER RUN TRL
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City | SHARPSBURG
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State | GA
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Zip | 30277-1994
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Country | US
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Telephone | 269-369-5639
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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 | 209005864
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN201155
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License Number State | GA
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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 | 4704173262
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28108068A
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License Number State | IN
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