Individual
MRS. LAURA A GULLICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6325 W JOHNS XING, JOHNS CREEK, GA 30097-5746
(404) 778-8311
(770) 495-1585
Mailing address
4935 SAVANNAH RUN, CUMMING, GA 30040-0280
(678) 549-1681
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN144532
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00834094A
—
GA
Enumeration date
12/04/2007
Last updated
09/12/2010
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