Provider Demographics
NPI:1114937430
Name:MUIR, LAURA F (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:F
Last Name:MUIR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:FASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7684367A00000X
TNAPN0000007684367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100025078OtherCARITEN PREF HEALTH PTNSH
TN3495113Medicaid
TN3107659OtherBLUE CROSS BLUE SHIELD