Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-159380 | AL |
NPI | 1396212239 |
---|---|
Provider Name | Madelyn Smith |
First Address | Moody, AL 35004-3520 |
Second Address | Birmingham, AL 35233-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2018 |
Last Update Date | 29/10/2018 |