Provider Demographics
NPI:1700143328
Name:DONNELLY, LAURA STALLBAUMER (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:STALLBAUMER
Last Name:DONNELLY
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 1:6715 W 156TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3597
Mailing Address - Country:US
Mailing Address - Phone:913-523-4561
Mailing Address - Fax:
Practice Address - Street 1:8717 W 110TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14100436072163W00000X
MO2009010446163W00000X
KS43557080072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse