Healthcare Provider Details

I. General information

NPI: 1083873293
Provider Name (Legal Business Name): NONA RUTH HURST CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 UNIVERSITY BLVD
BIRMINGHAM AL
35233-3408
US

IV. Provider business mailing address

2151 OLD ROCKY RIDGE RD SUITE 106
BIRMINGHAM AL
35216-7235
US

V. Phone/Fax

Practice location:
  • Phone: 205-989-1080
  • Fax: 205-989-1087
Mailing address:
  • Phone: 205-989-1080
  • Fax: 205-989-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-019516
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: