Healthcare Provider Details

I. General information

NPI: 1841236775
Provider Name (Legal Business Name): ANNE WANK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE D430B
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE D430B
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-631-3270
  • Fax: 251-631-3273
Mailing address:
  • Phone: 251-631-3270
  • Fax: 251-631-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10190
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-030812
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: