Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 1-128513 | AL |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-128513 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-128513 | AL |
NPI | 1083001523 |
---|---|
Provider Name | William W Recknor |
First Address | Birmingham, AL 35235-3430 |
Second Address | Birmingham, AL 35235-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 24/04/2015 |