Individual
JENNIFER HAGAN MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
213 LIGHTWOOD RD STE 1, DEATSVILLE, AL 36022-3800
(334) 543-4164
(334) 543-4165
Mailing address
564 N MEMORIAL DR, PRATTVILLE, AL 36067-2132
(334) 358-2010
(334) 358-2013
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-100304
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-100304
LICENSE NUMBER
AL
Enumeration date
08/17/2009
Last updated
11/28/2022
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