Active NPI
Laura M. Moran, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Loves Park, IL
National Provider Identifier
1669581690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- Practice address
- 2202 Harlem Rd
Loves Park, IL 61111-2754 - Phone
- (815) 877-4848
- Fax
- (815) 654-5342
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | IL | Primary |
Addresses
Primary practice location
2202 Harlem Rd
Loves Park, IL 61111-2754
Mailing address
2202 Harlem Rd
Loves Park, IL 61111-2754
Phone (815) 877-4848
Other names 1
- Laura M. Stack
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-005048 | IL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health Providence Hospital | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| St. Joseph Mercy Hospital Crna Group | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Rockford Anesthesiologists Associated, L.L.C. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Certified Registered Nurse Anesthetist
- Loves Park, IL
- NPI 1629090642
Nurse Anesthetist, Certified Registered
-
dba Henry Ford Providence Hospital
- Certified Registered Nurse Anesthetist
- Southfield, MI
- NPI 1851339196
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Pontiac, MI
- NPI 1568493047
Nurse Anesthetist, Certified Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669581690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2202 HARLEM RD",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611112754",
"telephone_number": "815-877-4848",
"fax_number": "815-654-5342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2202 HARLEM RD",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611112754",
"telephone_number": "815-877-4848",
"fax_number": "815-654-5342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN",
"first_name": "LAURA",
"middle_name": "M.",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LAURA",
"last_name": "STACK",
"middle_name": "M.",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.