Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 1-127570 | AL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | RN1020730 | DC |
NPI | 1023426442 |
---|---|
Provider Name | Miss Alexandra Blumenthal |
First Address | Birmingham, AL 35233-1723 |
Second Address | Birmingham, AL 35233-1723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 29/07/2014 |