Provider Demographics
NPI:1952376055
Name:BUSENLEHNER, TERRY DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DOUGLAS
Last Name:BUSENLEHNER
Suffix:
Gender:M
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0038
Mailing Address - Country:US
Mailing Address - Phone:256-235-8900
Mailing Address - Fax:256-236-2503
Practice Address - Street 1:301 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3952
Practice Address - Country:US
Practice Address - Phone:256-235-8900
Practice Address - Fax:256-236-2503
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-034644367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51511083OtherBCBS #
ALR94348Medicare UPIN