Individual
MS. SUSAN G WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2105 EAST SOUTH BLVD, MONTGOMERY, AL 36116
(334) 288-2100
Mailing address
PO BOX 235022, MONTGOMERY, AL 36123-5022
(334) 386-2051
(334) 396-6929
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1035451
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051513181
BLUE CROSS
AL
05
—
051552510
—
AL
Enumeration date
05/16/2006
Last updated
04/15/2015
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