Healthcare Provider Details

I. General information

NPI: 1952462491
Provider Name (Legal Business Name): TERRI YEVETTE MARSDEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WATER ELM DR
MAYLENE AL
35114-4919
US

IV. Provider business mailing address

119 WATER ELM DR
MAYLENE AL
35114-4919
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-2212
  • Fax:
Mailing address:
  • Phone: 205-664-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-094661
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00626
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: