Healthcare Provider Details

I. General information

NPI: 1700069887
Provider Name (Legal Business Name): HEATHER LACONYA VEAL FIELDS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER VEAL FIELDS CRNA

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 48TH ST
VALLEY AL
36854-3666
US

IV. Provider business mailing address

PO BOX 661495
BIRMINGHAM AL
35266-1495
US

V. Phone/Fax

Practice location:
  • Phone: 334-756-1848
  • Fax: 334-756-1854
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-078798
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: