Provider Demographics
NPI:1073590477
Name:HOLUB, LAURA HINES (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:HINES
Last Name:HOLUB
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228669367500000X
TXAP101995367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154621003Medicaid
TX154621004Medicaid
TX154621001Medicaid
TX154621002Medicaid
TX154621005Medicaid
TX82938UOtherBCBS
TX154621006Medicaid
TX430079633OtherRAILROAD
TX154621004Medicaid
TX8C6911Medicare PIN
TXTXB101085Medicare PIN
TX82938UOtherBCBS
TX8B5589Medicare PIN
TX154621005Medicaid