Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1-093408 | AL |
NPI | 1003320086 |
---|---|
Provider Name | Mrs. Wendy Lanessa Orr |
First Address | Birmingham, AL 35246 |
Second Address | Red Bay, AL 35582-3858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 18/09/2020 |