Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-104237 | AL |
NPI | 1003194499 |
---|---|
Provider Name | Mrs. Kathleen R. Carlen-Magnone |
First Address | Mobile, AL 36685-0489 |
Second Address | Mobile, AL 36608-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 02/08/2011 |