Provider Demographics
NPI:1659816197
Name:SHOEMAKER, CALLIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 830550
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0550
Mailing Address - Country:US
Mailing Address - Phone:334-247-8769
Mailing Address - Fax:334-377-4417
Practice Address - Street 1:3690 GRANDVIEW PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:334-247-8769
Practice Address - Fax:334-377-4417
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-34497163W00000X
AL114343367500000X
AL1-134497367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse