Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-030342 | AL |
NPI | 1083790539 |
---|---|
Provider Name | Mrs. Sylvia Anderson |
First Address | Opelika, AL 36803-2527 |
Second Address | Opelika, AL 36801-5449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R84808 | (02) | AL |