Provider Demographics
NPI:1992713093
Name:HARWOOD, DONITA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:DONITA
Middle Name:MARIE
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DONITA
Other - Middle Name:M
Other - Last Name:PANTALONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:DEPT 2290, P O BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2290
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-8120
Practice Address - Fax:256-265-8969
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-076024367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530629OtherBCBS #
AL051530629Medicaid
AL51530629OtherBCBS #
AL051530629Medicaid