Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-113680 | AL |
NPI | 1033640255 |
---|---|
Provider Name | Laura Crum |
First Address | Montgomery, AL 36124-1587 |
Second Address | Montgomery, AL 36117-3507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 21/03/2017 |