Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42536 | AL |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 42536 | AL |
NPI | 1245737964 |
---|---|
Provider Name | Alexandria Lynelle Broadnax |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 20/07/2021 |