Basic Information
| Provider Information | |||||||||
| NPI: | 1184688327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAURO | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LILLY RD NE STE 204 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138250 | ||||||||
| FaxNumber: | 3604138830 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 LILLY RD NE STE 204 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604138250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 228109 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000782812E | 05 | GA | MEDICAID | 013363400 | 05 | FL | MEDICAID | 2606515 | 01 | NC | MEDICARE PTAN | OTHER | 8053455 | 05 | NC | MEDICAID |