Healthcare Provider Details

I. General information

NPI: 1508162090
Provider Name (Legal Business Name): CHRISTY M PUTMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BIG COVE RD SE
HUNTSVILLE AL
35801-3750
US

IV. Provider business mailing address

PO BOX 1389
HUNTSVILLE AL
35807-0389
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-8120
  • Fax: 256-265-8969
Mailing address:
  • Phone: 256-265-8120
  • Fax: 256-265-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-097713
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: