Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1-10256 | AL |
NPI | 1003242678 |
---|---|
Provider Name | Ms. Laura Paige Farris |
First Address | Birmingham, AL 35233 |
Second Address | Pell City, AL 35125-1243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 05/08/2016 |