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Individual

MARY K BRETHOUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
602 W UNIVERSITY AVE, PROVIDER ENROLLMENT - NCWY, URBANA, IL 61801-2530
(217) 383-6792
(217) 326-2856

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-075081
AL

Other

Enumeration date
04/29/2008
Last updated
02/01/2012
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