Individual
LARA BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-5037
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024177780
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
1114007
TX
367500000X
Certified Registered Nurse Anesthetist
685792
NY
Other
Enumeration date
08/28/2018
Last updated
06/27/2023
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