Individual
LAURA JEAN FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13601 PRESTON RD, SUITE 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Mailing address
PO BOX 660857, DALLAS, TX 75266-0857
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704285066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114202934
—
MI
01
—
4308718480
BCBS
MI
01
—
P01015922
RAILROAD MEDICARE
MI
Enumeration date
10/12/2011
Last updated
03/19/2014
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