Individual
AMANDA N WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
619 19TH ST S, ROOM - JT845, BIRMINGHAM, AL 35249-1900
(205) 934-7072
(205) 975-5963
Mailing address
PO BOX 11407, DEPARTMENT 1717, BIRMINGHAM, AL 35246-1717
(205) 934-7072
(205) 975-5963
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-110630
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
1-110630
AL
Other
Enumeration date
12/14/2010
Last updated
02/21/2011
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