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Individual
MARY LOU QUATTLEBAUM
Active
Individual
MARY LOU QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
1076934
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51530690
BCBS OF AL
AL
05
—
891010260
—
AL
Enumeration date
11/21/2005
Last updated
09/24/2013
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