Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1-121908 | AL |
NPI | 1003497876 |
---|---|
Provider Name | Mrs. Sumitra Patel |
First Address | Elkmont, AL 35620-3454 |
Second Address | Pulaski, TN 38478-4705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 19/08/2021 |