Individual
ELIZABETH DIANE HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4370 W MAIN ST, DOTHAN, AL 36305
(334) 793-5000
(334) 615-8419
Mailing address
PO BOX 6907, DOTHAN, AL 36302
(334) 793-5000
(334) 615-8419
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1032751
AL
367500000X
Certified Registered Nurse Anesthetist
1515226
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03258298
—
MS
05
—
1772534
—
LA
01
—
2500206
UNITED HEALTHCARE
—
01
—
51515733
BLUE CROSS BLUE SHIELD OF
AL
01
—
P00089320
RAILROAD MEDICARE
—
Enumeration date
04/18/2006
Last updated
07/08/2007
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