Individual
LAURA J HEARST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4562
(207) 662-6236
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-4562
(207) 662-6236
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
125032
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA83441
ME
367500000X
Certified Registered Nurse Anesthetist
SRA-100001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32408552
—
CO
01
—
P00860353
RR MEDICARE
CO
Enumeration date
06/25/2008
Last updated
01/30/2015
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