Individual
MRS. MARY JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3750 PROFESSIONAL PKWY, MOBILE, AL 36609-5407
(251) 460-0999
Mailing address
29653 ANCHOR CROSS BLVD, DAPHNE, AL 36526-9594
(251) 625-6896
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1-112783
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245903
—
AL
05
—
246049
—
AL
05
—
248711
—
AL
01
—
A871121V
MEDICARE PTAN
AL
01
—
P02453396
RAILROAD MEDICARE
AL
Enumeration date
08/05/2019
Last updated
10/27/2021
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