Provider Demographics
NPI:1417991753
Name:BURTIN, THELMA F (CRNP)
Entity type:Individual
Prefix:MS
First Name:THELMA
Middle Name:F
Last Name:BURTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 19TH STREET ENSLEY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1642
Mailing Address - Country:US
Mailing Address - Phone:205-788-2200
Mailing Address - Fax:205-788-2201
Practice Address - Street 1:321 19TH STREET ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1642
Practice Address - Country:US
Practice Address - Phone:205-788-2200
Practice Address - Fax:205-788-2201
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065633207P00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524778Medicaid
Q29925Medicare UPIN
AL051524778Medicaid