Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-133900 | AL |
NPI | 1033745294 |
---|---|
Provider Name | William Jackson Steele SR. |
First Address | Tuscaloosa, AL 35401-5826 |
Second Address | Northport, AL 35476-3360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 19/03/2020 |