Healthcare Provider Details

I. General information

NPI: 1487590451
Provider Name (Legal Business Name): GRACE LOVELESS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

3104 BLUE LAKE DR
VESTAVIA AL
35243-2345
US

V. Phone/Fax

Practice location:
  • Phone: 833-251-9895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-193182
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: