Healthcare Provider Details

I. General information

NPI: 1891293627
Provider Name (Legal Business Name): DANIELLE L HALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WINTER ST
LUCEDALE MS
39452-6603
US

IV. Provider business mailing address

51 TACON ST STE D
MOBILE AL
36607-3123
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-3161
  • Fax:
Mailing address:
  • Phone: 251-341-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-130099
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901938
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: