Provider Demographics
NPI:1053319020
Name:DEPAS, LAURA LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:DEPAS
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 1:7760 ACHTERMAN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PLAIN
Mailing Address - State:OH
Mailing Address - Zip Code:45162-9261
Mailing Address - Country:US
Mailing Address - Phone:513-260-3188
Mailing Address - Fax:513-877-3320
Practice Address - Street 1:7760 ACHTERMAN RD
Practice Address - Street 2:
Practice Address - City:PLEASANT PLAIN
Practice Address - State:OH
Practice Address - Zip Code:45162-9261
Practice Address - Country:US
Practice Address - Phone:513-260-3188
Practice Address - Fax:513-877-3320
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.191186-COA1367500000X
IN28188333A367500000X
NC5315367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0763704Medicaid
OHH036096Medicare PIN
OH0763704Medicaid
OH0763704Medicaid