Provider Demographics
NPI:1215334594
Name:CULLMAN REGIONAL NURSE ANESTHETISTS, LLC
Entity type:Organization
Organization Name:CULLMAN REGIONAL NURSE ANESTHETISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:334-396-6930
Mailing Address - Street 1:7956 VAUGHN RD # 165
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6625
Mailing Address - Country:US
Mailing Address - Phone:888-316-7491
Mailing Address - Fax:334-239-7654
Practice Address - Street 1:1912 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-051912367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty