Provider Demographics
NPI:1598755290
Name:HYATT, LAURA L (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:HYATT
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 1:2510 BERT KOUNS LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3119
Mailing Address - Country:US
Mailing Address - Phone:318-212-5220
Mailing Address - Fax:
Practice Address - Street 1:2510 BERT KOUNS LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3119
Practice Address - Country:US
Practice Address - Phone:318-212-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO1680367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1906034Medicaid
LARN048093OtherRN LICENSE
LAAPO1680OtherADVANCED PRACTICE RN
LAAPO1680OtherNURSE ANESTHESIA
LARN048093OtherRN LICENSE
LAAPO1680OtherNURSE ANESTHESIA