Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-105427 | AL |
NPI | 1003140971 |
---|---|
Provider Name | Mrs. Andrea S. Higginbotham |
First Address | Birmingham, AL 35235-3401 |
Second Address | Birmingham, AL 35235-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2009 |
Last Update Date | 06/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011846 | MEDICARE GROUP PAYEE NUMBER (01) | AL |
1063439065 | NPI SITE GROUP PAYEE NUMBER (01) | AL |
630000013 | (05) | AL |