Healthcare Provider Details

I. General information

NPI: 1326216656
Provider Name (Legal Business Name): SHIRLEY P. ROWLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SUMRALL RD
COLUMBIA MS
39429-2654
US

IV. Provider business mailing address

PO BOX 630
COLUMBIA MS
39429-0630
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-6303
  • Fax: 601-740-2233
Mailing address:
  • Phone: 601-736-6303
  • Fax: 601-740-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR104120
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: