Healthcare Provider Details

I. General information

NPI: 1972185627
Provider Name (Legal Business Name): MICHAELA LANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

1501 CYPRESS LN
HOOVER AL
35244-8249
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1000
  • Fax:
Mailing address:
  • Phone: 270-543-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-156512
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: