Provider Demographics
NPI:1306112297
Name:CRUNK, ALICE M (CRNA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:CRUNK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:M
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 660685
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0685
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-325-8100
Practice Address - Fax:205-325-8809
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220377367500000X
AL1-109914367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered