Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-085113 | AL |
NPI | 1013351758 |
---|---|
Provider Name | Mrs. Katherine Lineberry Mange |
First Address | Birmingham, AL 35233-2028 |
Second Address | Birmingham, AL 35233-2110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 24/04/2013 |