Individual
BEVIN LYLE ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
832 PRINCETON AVE SW, BIRMINGHAM, AL 35211-1320
(205) 206-8450
(205) 206-8364
Mailing address
PO BOX 12366, BIRMINGHAM, AL 35202-2366
(205) 780-7101
(205) 206-8338
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1-140234
AL
363LG0600X
Gerontology Nurse Practitioner
1-140234
AL
363LP2300X
Primary Care Nurse Practitioner
Primary
1-140234
AL
Other
Enumeration date
08/21/2017
Last updated
03/17/2018
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