Provider Demographics
NPI:1285904557
Name:AMUSO, STEPHANIE DOSS (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DOSS
Last Name:AMUSO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9461 AMBROSE LN
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:AL
Mailing Address - Zip Code:35091-2020
Mailing Address - Country:US
Mailing Address - Phone:205-520-6020
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:ROOM- JT845
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-934-7072
Practice Address - Fax:205-975-5963
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113066367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered