Provider Demographics
NPI:1609148048
Name:SIQUEIRA, ANNIE MALONE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MALONE
Last Name:SIQUEIRA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:KATHERINE
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:619 19TH ST S RM JT845
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-979-5882
Practice Address - Fax:205-979-1248
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16377367500000X
TNRN185301367500000X
AL1-144155367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527227Medicaid
TN4316382OtherBCBS OF TN
TN1527227Medicaid