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NPI Code Detail

MEDICARE: MARY LOU QUATTLEBAUM CRNP

MEDICARE: MARY LOU QUATTLEBAUM 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
1163WG0000XGeneral Practice Registered Nurse1076934AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151530690OTHERALBCBS OF AL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639152994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LOU QUATTLEBAUM CRNP
Provider Business Mailing Address
First Line : PO BOX 18488
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35804-8488
Country : US
Telephone Number : 256-533-6311
Fax Number : 256-536-0801
Provider Business Practice Location Address
First Line : 751 PLEASANT ROW NW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35816-2537
Country : US
Telephone Number : 256-533-6311
Fax Number : 256-536-0801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 09/24/2013

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