Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2243 | AL |
NPI | 1124292198 |
---|---|
Provider Name | Dr. Nicole Smith Ussery |
First Address | Vestavia Hills, AL 35216-2806 |
Second Address | Vestavia Hills, AL 35216-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2008 |
Last Update Date | 21/04/2008 |