Provider Demographics
NPI:1487043162
Name:FARLEY, LAURA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S WRENHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2370
Mailing Address - Country:US
Mailing Address - Phone:801-910-8533
Mailing Address - Fax:
Practice Address - Street 1:6355 S WRENHAVEN RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2370
Practice Address - Country:US
Practice Address - Phone:801-910-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6962510-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered