Healthcare Provider Details

I. General information

NPI: 1407302128
Provider Name (Legal Business Name): LAURA BURDETTE MCFALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SW
FORT PAYNE AL
35968-3458
US

IV. Provider business mailing address

1616 MAIN ST W
RAINSVILLE AL
35986-6745
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-3150
  • Fax:
Mailing address:
  • Phone: 256-605-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111907
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-126369
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000184541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: