Provider Demographics
NPI:1851988596
Name:BURCH, LESLEY ERIN (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ERIN
Last Name:BURCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ERIN
Other - Last Name:BRAENNSTROEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:2100 SPRING HILL AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3323
Mailing Address - Country:US
Mailing Address - Phone:513-828-7900
Mailing Address - Fax:
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-167609367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty