Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-138659 | AL |
NPI | 1043684822 |
---|---|
Provider Name | Christopher Carlson |
First Address | Birmingham, AL 35211-1323 |
Second Address | Birmingham, AL 35211-1323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2015 |
Last Update Date | 13/12/2017 |