Provider Demographics
NPI:1437101086
Name:PETERS, LAWRENCE CARLTON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CARLTON
Last Name:PETERS
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 1:2612 HIDDEN HILL CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6997
Mailing Address - Country:US
Mailing Address - Phone:870-935-7106
Mailing Address - Fax:
Practice Address - Street 1:623 E MATTHEWS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3145
Practice Address - Country:US
Practice Address - Phone:870-934-8010
Practice Address - Fax:870-934-8010
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00614 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59648Medicare ID - Type UnspecifiedCRNA