Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-119026 | AL |
NPI | 1013347707 |
---|---|
Provider Name | Mrs. Brady Burge |
First Address | Mobile, AL 36606-4060 |
Second Address | Mobile, AL 36606-4060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 11/02/2015 |