Healthcare Provider Details

I. General information

NPI: 1043553084
Provider Name (Legal Business Name): CHRISTINE LEIGH FUTCH PICKRELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 POND VIEW RD
EVANS GA
30809-6681
US

IV. Provider business mailing address

129 POND VIEW RD
EVANS GA
30809-6681
US

V. Phone/Fax

Practice location:
  • Phone: 706-284-3163
  • Fax:
Mailing address:
  • Phone: 706-284-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN188391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: