Provider Demographics
NPI:1114180205
Name:NOE, LAURIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:NOE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:ARNZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 4268
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4268
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-6416
Practice Address - Fax:208-367-2742
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-725367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8081095Medicaid
ID1605205Medicare PIN