Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-135680 | AL |
NPI | 1013484278 |
---|---|
Provider Name | Mrs. Rebecca Elizabeth Smith |
First Address | Winfield, AL 35594-6938 |
Second Address | Birmingham, AL 35233-1502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |