Healthcare Provider Details

I. General information

NPI: 1275426058
Provider Name (Legal Business Name): MARTINA MIMS WRIGHT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1000
  • Fax:
Mailing address:
  • Phone: 251-266-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-162853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: