1669452587 NPI number — MRS. MARCIA DELOIS BOSWELL CRNA

Table of content: MRS. MARCIA DELOIS BOSWELL CRNA (NPI 1669452587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669452587 NPI number — MRS. MARCIA DELOIS BOSWELL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSWELL
Provider First Name:
MARCIA
Provider Middle Name:
DELOIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOSWELL
Provider Other First Name:
MARCIA
Provider Other Middle Name:
GRAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669452587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 235022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36123-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
354-386-2051
Provider Business Mailing Address Fax Number:
334-396-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 PRINCETON AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35211-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-783-3144
Provider Business Practice Location Address Fax Number:
205-783-3195
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  1041480 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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