Healthcare Provider Details

I. General information

NPI: 1710779673
Provider Name (Legal Business Name): EMILY JEUDE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAGLE VIEW DR
NEW MARKET AL
35761-7747
US

IV. Provider business mailing address

100 EAGLE VIEW DR
NEW MARKET AL
35761-7747
US

V. Phone/Fax

Practice location:
  • Phone: 615-943-3045
  • Fax:
Mailing address:
  • Phone: 615-943-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-169271
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: