Healthcare Provider Details

I. General information

NPI: 1235841198
Provider Name (Legal Business Name): BIANCA CRENSHAW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 EDMONTON DR
BESSEMER AL
35022-4878
US

IV. Provider business mailing address

329 OBSERVATORY DR
BIRMINGHAM AL
35206-3042
US

V. Phone/Fax

Practice location:
  • Phone: 205-425-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1-114856
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: