Provider Demographics
NPI:1346220332
Name:DEGUENTHER, LAURA R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:R
Last Name:DEGUENTHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:RENEA
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-386-2051
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:800 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213
Practice Address - Country:US
Practice Address - Phone:205-592-1785
Practice Address - Fax:205-592-1785
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1079965367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051553863Medicaid
AL051553863Medicaid
AL051553863Medicare ID - Type Unspecified