Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1-093057 | AL |
NPI | 1013166826 |
---|---|
Provider Name | Holli Ann Burden |
First Address | Mobile, AL 36603-5827 |
Second Address | Mobile, AL 36603-5827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 19/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063439065 | NPI GROUP PAYEE NUMBER (01) | AL |
630000013 | (05) | AL |