Provider Demographics
NPI:1124205034
Name:LAVER, THOMAS ERIC (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ERIC
Last Name:LAVER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ANN ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-8807
Mailing Address - Country:US
Mailing Address - Phone:312-388-4440
Mailing Address - Fax:
Practice Address - Street 1:11 ANN ARBOR CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-8807
Practice Address - Country:US
Practice Address - Phone:312-388-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2023-05-26
Deactivation Date:2022-06-21
Deactivation Code:
Reactivation Date:2023-05-26
Provider Licenses
StateLicense IDTaxonomies
IL209006954367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered