MEDICARE: NANCY BRADFORD CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1-029778	AL

General Provider Information

NPI Number	:	1487609061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BRADFORD CRNA

Provider Business Mailing Address
First Line	:	PO BOX 55059
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5059
Country	:	US
Telephone Number	:	256-764-9697
Fax Number	:	256-764-9699

Provider Business Practice Location Address
First Line	:	4511 SOUTHLAKE PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-3238
Country	:	US
Telephone Number	:	205-985-4398
Fax Number	:	205-502-5152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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