Healthcare Provider Details

I. General information

NPI: 1659721660
Provider Name (Legal Business Name): DANIEL VRAZEL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 BLUE LAKE DR SUITE 110
VESTAVIA AL
35243-2345
US

IV. Provider business mailing address

3104 BLUE LAKE DR SUITE 110
VESTAVIA AL
35243-2345
US

V. Phone/Fax

Practice location:
  • Phone: 334-247-8769
  • Fax: 334-377-4417
Mailing address:
  • Phone: 334-247-8769
  • Fax: 334-377-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-22772
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: