Individual
ALISHA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5760 CARMICHAEL PKWY, MONTGOMERY, AL 36117-2338
(334) 361-8555
Mailing address
1362 INDIAN HILLS RD, PRATTVILLE, AL 36067-7037
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
1-088225
AL
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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