Healthcare Provider Details

I. General information

NPI: 1588643720
Provider Name (Legal Business Name): FORREST LEE NEESE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST
MOBILE AL
36617-2238
US

IV. Provider business mailing address

414 AVALON ST
MOBILE AL
36608-5817
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7035
  • Fax: 251-471-7042
Mailing address:
  • Phone: 251-345-3316
  • Fax: 251-345-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11026976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: