Healthcare Provider Details

I. General information

NPI: 1053240242
Provider Name (Legal Business Name): BREANNA ROSE GREIVING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

418 CURIE BLVD
PHILADELPHIA PA
19104-4217
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN763604
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: