Healthcare Provider Details

I. General information

NPI: 1972800779
Provider Name (Legal Business Name): ELIZABETH DENISE PICKARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EDWARDS ST
ENTERPRISE AL
36330-2510
US

IV. Provider business mailing address

PO BOX 9138
BELFAST ME
04915-9138
US

V. Phone/Fax

Practice location:
  • Phone: 334-393-8701
  • Fax: 334-347-2080
Mailing address:
  • Phone: 877-848-1463
  • Fax: 615-465-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-097213
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: