Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2-123456 | AL |
NPI | 1013257476 |
---|---|
Provider Name | Sula Mcelroy Gillespie |
First Address | Birmingham, AL 35233 |
Second Address | Birmingham, AL 35233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 03/06/2013 |