Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1081273 | AL |
NPI | 1043601529 |
---|---|
Provider Name | Traci Marlowe |
First Address | Birmingham, AL 35242-6410 |
Second Address | Birmingham, AL 35242-6410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2015 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13792350 | CAQH (01) | AL |
51157383 | BLUE CROSS BLUE SHIELD OF ALABAMA (01) | AL |