MEDICARE: JENNIFER LAURIN

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	95000592	CA

General Provider Information

NPI Number	:	1538529649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAURIN

Provider Business Mailing Address
First Line	:	291 CALLE TRANQUILLO
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5106
Country	:	US
Telephone Number	:	818-442-3466
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 CALLE TRANQUILLO
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5106
Country	:	US
Telephone Number	:	818-442-3466
Fax Number	:

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	10/06/2016

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