Individual
MS. LAURA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
(615) 327-7940
Mailing address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
(615) 327-7940
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN11310
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10069805
AMERIGROUP
TN
05
—
3633960
—
TN
01
—
4077106
BCBS
TN
01
—
5542541
FIRST HEALTH
TN
01
—
74008939
KY MEDICAID
KY
Enumeration date
06/30/2006
Last updated
05/10/2019
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