Provider Demographics
NPI:1235174178
Name:MCMULLAN, SUSAN PARRY (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PARRY
Last Name:MCMULLAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1816
Mailing Address - Country:US
Mailing Address - Phone:205-325-8387
Mailing Address - Fax:205-325-8594
Practice Address - Street 1:1720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-325-8387
Practice Address - Fax:205-325-8594
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041236227367500000X
AL1-148148367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered