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NPI Code Detail

MEDICARE: MARCELLE PRAETORIUS CRNP

MEDICARE: MARCELLE PRAETORIUS CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerF1196167AL

General Provider Information

NPI Number : 1043276595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLE PRAETORIUS CRNP
Provider Business Mailing Address
First Line : 4212 CARMICHAEL CT N
Second Line :
City : MONTGOMERY
State : AL
Zip : 36106-3621
Country : US
Telephone Number : 334-213-8803
Fax Number : 334-213-8815
Provider Business Practice Location Address
First Line : 4212 CARMICHAEL CT N
Second Line :
City : MONTGOMERY
State : AL
Zip : 36106-3621
Country : US
Telephone Number : 334-213-8803
Fax Number : 334-213-8815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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Directions to “ MARCELLE PRAETORIUS CRNP” Practice Location

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