Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1-106936 | AL |
NPI | 1023303500 |
---|---|
Provider Name | Terry Ann Marcen Sturm |
First Address | Florala, AL 36442-3231 |
Second Address | Florala, AL 36442-3231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 13/06/2011 |