Provider Demographics
NPI:1033199039
Name:BROCK, PAULA FREEBURG (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:FREEBURG
Last Name:BROCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:K
Other - Last Name:FREEBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-396-6930
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:800 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1908
Practice Address - Country:US
Practice Address - Phone:205-592-1785
Practice Address - Fax:205-592-1785
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1065058367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000075112Medicaid
AL000075112Medicaid
AL000075112Medicare ID - Type Unspecified