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Individual

MARTHA JANE LAIRD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1024 KELLY DRIVE, VANDYCK AMBULATORY SURGERY CENTER-LODEN VISION, PARIS, TN 38242-4500
(731) 642-5003
(615) 620-2323
Mailing address
PO BOX 291264, NASHVILLE, TN 37229-1264
(615) 620-2320
(615) 620-2323

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN039384
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN08847
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01191925
AMERIGROUP TENNCARE-NONPAR
TN
Enumeration date
07/03/2006
Last updated
10/01/2010
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