Healthcare Provider Details

I. General information

NPI: 1265997456
Provider Name (Legal Business Name): NATHANAEL PETER NALBACH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

2510 GENOA WAY APT 4
VESTAVIA AL
35243-7002
US

V. Phone/Fax

Practice location:
  • Phone: 256-642-1753
  • Fax:
Mailing address:
  • Phone: 256-642-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-140860
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: