MEDICARE: LAURA FARLEY CRNA PLLC

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	6962510-4406	UT

General Provider Information

NPI Number	:	1083062319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA FARLEY CRNA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 886
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0886
Country	:	US
Telephone Number	:	801-296-2113
Fax Number	:	801-951-2351

Provider Business Practice Location Address
First Line	:	1485 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1438
Country	:	US
Telephone Number	:	801-296-2113
Fax Number	:	801-951-2351

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	LAURA ANN FARLEY
Credential	:	CRNA
Telephone Number	:	801-910-8533

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	06/30/2024

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