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General NPI Number Information
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NPI Number | 1083707814
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Entity Type | Individual
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Provider Name | KIMBERLY A.H. SUNDLAND CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-261-3606
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Fax | 601-579-5383
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Provider Business Mailing Address
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Address Line | 1420 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39402-3107
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Country | US
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Telephone | 601-264-3937
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Fax | 601-264-5930
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3870
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R813576
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License Number State | MS
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