Individual
MRS. LARA ANN HAYDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1635 NORTH LOOP WEST, HOUSTON, TX 77008-1593
(713) 400-2990
(713) 400-2993
Mailing address
PO BOX 22926, JACKSON, MS 39225-2926
(713) 400-2990
(713) 400-2993
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
648689
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
RN648689
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1692584-02
—
TX
01
—
86239U
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
05/01/2006
Last updated
08/23/2018
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