Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-143782 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-143782 | AL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1-143782 | AL |
NPI | 1003318619 |
---|---|
Provider Name | Andrea Dial |
First Address | Trussville, AL 35173-3816 |
Second Address | Birmingham, AL 35205-3423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |