Provider Demographics
NPI:1588786610
Name:LAVERTY, LAURIE JEAN (CRNA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:LAVERTY
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 1:1993 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1107
Mailing Address - Country:US
Mailing Address - Phone:401-884-7582
Mailing Address - Fax:401-456-3621
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-884-7582
Practice Address - Fax:401-456-3621
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36552367500000X
RIAPRN00170367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007009082Medicare ID - Type Unspecified