MEDICARE: LAURA PENTON LEE 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	APO1525	LA
2	367500000X	Certified Registered Nurse Anesthetist	585344	TX

General Provider Information

NPI Number	:	1609820505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PENTON LEE CRNA

Provider Business Mailing Address
First Line	:	2401 S GESSNER RD
Second Line	:	APT 336
City	:	HOUSTON
State	:	TX
Zip	:	77063-2056
Country	:	US
Telephone Number	:	318-623-9920
Fax Number	:	318-473-4007

Provider Business Practice Location Address
First Line	:	3030 S GESSNER RD
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77063-3765
Country	:	US
Telephone Number	:	713-587-0909
Fax Number	:	713-587-0912

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/26/2011

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Directions to “ LAURA PENTON LEE CRNA” Practice Location

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