Healthcare Provider Details

I. General information

NPI: 1548293970
Provider Name (Legal Business Name): DOROTHY C LOFTIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY C HOLDER CRNA

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

PO BOX 1123
JACKSON MI
49204-1123
US

V. Phone/Fax

Practice location:
  • Phone: 250-939-7143
  • Fax:
Mailing address:
  • Phone: 800-242-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-080810
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: