Healthcare Provider Details

I. General information

NPI: 1720012784
Provider Name (Legal Business Name): ANN MARIE KARST CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 WOODMERE BLVD
MONTGOMERY AL
36106-2918
US

IV. Provider business mailing address

72 PAYNE RD
MONTGOMERY AL
36116-6683
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-2002
  • Fax: 334-271-4523
Mailing address:
  • Phone: 334-244-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-052413
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: