Provider Demographics
NPI:1083754519
Name:HENRY, LAURA M (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:HENRY
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 1:905 KINLEY AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104
Mailing Address - Country:US
Mailing Address - Phone:505-242-2400
Mailing Address - Fax:
Practice Address - Street 1:905 KINLEY AVENUE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104
Practice Address - Country:US
Practice Address - Phone:505-242-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9163037367500000X
NMCRNA-01261367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL591-91294OtherBLUE CROSS BLUE SHIELD
FLG4164OtherBLUE CROSS BLUE SHIELD
AL009941156Medicaid
FL308160500Medicaid
FLP00380939OtherMEDICARE RAILROAD
AL009941156Medicaid