Organization
MERIDIAN CRNA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA J. FUNCK (EXECUTIVE DIRECTOR)
(601) 485-6325
Entity
Organization
Contact information
Practice address
4700 26TH AVE, MERIDIAN, MS 39305-4706
(601) 485-6325
(601) 485-3061
Mailing address
4700 26TH AVE, MERIDIAN, MS 39305-4706
(601) 485-6325
(601) 485-3061
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07883328
—
MS
Enumeration date
08/13/2006
Last updated
09/04/2013
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