Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1016651 | AL |
NPI | 1033225255 |
---|---|
Provider Name | Alice Mae Cunningham |
First Address | Tuscaloosa, AL 35401-1250 |
Second Address | Tuscaloosa, AL 35401-1250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51523074 | BCBS (01) | |
Q05835 | (02) |