Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-126937 | AL |
NPI | 1003298654 |
---|---|
Provider Name | Jessica Cha |
First Address | Birmingham, AL 35242 |
Second Address | Birmingham, AL 35294-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 19/06/2015 |