Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1-029788 | AL |
NPI | 1003852609 |
---|---|
Provider Name | Dolores Bray |
First Address | Mobile, AL 36693-3316 |
Second Address | Mobile, AL 36608-5821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 29/05/2020 |