Healthcare Provider Details

I. General information

NPI: 1730415969
Provider Name (Legal Business Name): MARIA BEDARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

3104 BLUE LAKE DR STE 110
VESTAVIA AL
35243-2372
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1000
  • Fax:
Mailing address:
  • Phone: 205-977-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-093164
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-093164
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: