Healthcare Provider Details

I. General information

NPI: 1801849187
Provider Name (Legal Business Name): JODI BLOOMSTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI TURNER CRNA

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 19TH ST S
BIRMINGHAM AL
35209-1913
US

IV. Provider business mailing address

PO BOX 757
FLORENCE AL
35631-0757
US

V. Phone/Fax

Practice location:
  • Phone: 205-322-3332
  • Fax:
Mailing address:
  • Phone: 256-764-9697
  • Fax: 256-764-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-087817
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: