Individual
NWADA OTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4601 WHITESBURG DR SE STE 101, HUNTSVILLE, AL 35802-1677
(256) 763-0628
Mailing address
4601 WHITESBURG DR SE STE 101, HUNTSVILLE, AL 35802-1677
(256) 763-0628
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-128976
AL
Other
Enumeration date
01/24/2022
Last updated
01/24/2022
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