Healthcare Provider Details

I. General information

NPI: 1871617530
Provider Name (Legal Business Name): GENE ELLEN BRUMLEY HOLT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARENGO STREET
FLORENCE AL
35634
US

IV. Provider business mailing address

PO BOX 10005
FLORENCE AL
35631-2005
US

V. Phone/Fax

Practice location:
  • Phone: 256-768-9191
  • Fax: 256-768-9775
Mailing address:
  • Phone: 256-768-9191
  • Fax: 256-768-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-099684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: