Provider Demographics
NPI:1841326782
Name:INGBER, LAWRENCE I (CRNA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:I
Last Name:INGBER
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 1:3855 WALSH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9223
Mailing Address - Country:US
Mailing Address - Phone:904-686-5017
Mailing Address - Fax:
Practice Address - Street 1:920 COUNTRY CLUB RD STE 220B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6090
Practice Address - Country:US
Practice Address - Phone:541-342-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3023222163W00000X
FL3023222367500000X
OR200960010CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA236969908BMedicaid
FLP00672643Medicare PIN