Individual
MISS LAURA LINDSEY CHENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 260-2728
Mailing address
312 EASTLAKE DR, MADISON, MS 39110-6324
(601) 260-2728
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R874654
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I438621
MEDICARE PTAN
MS
Enumeration date
06/15/2011
Last updated
12/27/2016
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