Healthcare Provider Details

I. General information

NPI: 1376652545
Provider Name (Legal Business Name): MICHELLE L HOUSE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-1753
US

IV. Provider business mailing address

2407 S VAUGHAN DR
MOBILE AL
36605-3353
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-3000
  • Fax: 251-342-3043
Mailing address:
  • Phone: 217-971-7133
  • Fax: 251-342-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-075074
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: