Individual
MS. JENNIFER J. LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 HURLEY PLZ, FLINT, MI 48503-5902
(810) 257-9000
(810) 760-0440
Mailing address
1 HURLEY PLZ, 5TH FLOOR S.O.N., FLINT, MI 48503-5902
(810) 762-7038
(810) 760-0440
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704215008
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B56166
BLUE SHIELD
MI
05
—
4775447
—
MI
Enumeration date
07/19/2006
Last updated
07/08/2007
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