Provider Demographics
NPI:1033662754
Name:LACOUR, ELIZA (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:LACOUR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SANDRA MURAIDA WAY
Mailing Address - Street 2:APT 13J
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4694
Mailing Address - Country:US
Mailing Address - Phone:435-224-3953
Mailing Address - Fax:
Practice Address - Street 1:111 SANDRA MURAIDA WAY
Practice Address - Street 2:APT 13J
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4694
Practice Address - Country:US
Practice Address - Phone:435-224-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered