Healthcare Provider Details

I. General information

NPI: 1922009539
Provider Name (Legal Business Name): DEANA LYNNE ABERNATHEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MEDICAL CENTER PKWY
SELMA AL
36701-6748
US

IV. Provider business mailing address

10099 ROOKERY RD
PENSACOLA FL
32507-7205
US

V. Phone/Fax

Practice location:
  • Phone: 334-418-4105
  • Fax: 334-418-3546
Mailing address:
  • Phone: 850-497-8123
  • Fax: 850-497-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-098515
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: