Individual
AMY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10420 REVA RD N, CHUNCHULA, AL 36521-3330
(251) 490-5884
Mailing address
10420 REVA RD N, CHUNCHULA, AL 36521-3330
(251) 490-5884
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
1-071140
AL
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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