Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 1-130834 | AL |
NPI | 1043508245 |
---|---|
Provider Name | Mrs. Jessica Seay Peters |
First Address | Montgomery, AL 36111-2711 |
Second Address | Montgomery, AL 36116-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 21/07/2011 |