Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1-35504 | AL |
NPI | 1003276312 |
---|---|
Provider Name | Mrs. Haley Patrick Hill |
First Address | Moundville, AL 35474-6356 |
Second Address | Tuscaloosa, AL 35406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2016 |
Last Update Date | 02/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5381 | CRNP RX NUMBER (01) | AL |