Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 901815 | MS |
NPI | 1033660113 |
---|---|
Provider Name | Mrs. Bridget Bordelon Crain |
First Address | Birmingham, AL 35205-2881 |
Second Address | Birmingham, AL 35211-1350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2016 |
Last Update Date | 21/04/2020 |