MEDICARE: LAURA LOUISE DEPAS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN.191186-COA1	OH
2	367500000X	Certified Registered Nurse Anesthetist	28188333A	IN
3	367500000X	Certified Registered Nurse Anesthetist	5315	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LOUISE DEPAS CRNA

Provider Business Mailing Address
First Line	:	7760 ACHTERMAN RD
Second Line	:
City	:	PLEASANT PLAIN
State	:	OH
Zip	:	45162-9261
Country	:	US
Telephone Number	:	513-260-3188
Fax Number	:	513-877-3320

Provider Business Practice Location Address
First Line	:	7760 ACHTERMAN RD
Second Line	:
City	:	PLEASANT PLAIN
State	:	OH
Zip	:	45162-9261
Country	:	US
Telephone Number	:	513-260-3188
Fax Number	:	513-877-3320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/21/2022

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