Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2019042773 | AL |
NPI | 1598308215 |
---|---|
Provider Name | Megan Boissel |
First Address | Steele, AL 35987-3520 |
Second Address | Birmingham, AL 35235-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |