Provider Demographics
NPI:1376652545
Name:HOUSE, MICHELLE L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:HOUSE
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 1:2407 S VAUGHAN DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-3353
Mailing Address - Country:US
Mailing Address - Phone:217-971-7133
Mailing Address - Fax:251-342-3043
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-342-3000
Practice Address - Fax:251-342-3043
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-075074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104824Medicaid
ALCN0216OtherRAILROAD MEDICARE
ALCN0216OtherMEDICARE TRAVELERS
AL105274Medicaid
AL104824Medicaid