Healthcare Provider Details

I. General information

NPI: 1063458545
Provider Name (Legal Business Name): SUSAN GUIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 5TH AVE E
TUSCALOOSA AL
35401-7419
US

IV. Provider business mailing address

P O BOX 2153, DEPT 5075
BIRMINGHAM AL
35287-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-1770
  • Fax:
Mailing address:
  • Phone: 205-348-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number207Q00000X
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: