Healthcare Provider Details

I. General information

NPI: 1700864220
Provider Name (Legal Business Name): LINDA CHERYL DUBOIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WOODSTOCK AVE
ANNISTON AL
36207-3947
US

IV. Provider business mailing address

PO BOX 1887 1401 WOODSTOCK AVE
ANNISTON AL
36202-1887
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-0215
  • Fax: 256-237-0295
Mailing address:
  • Phone: 256-237-0215
  • Fax: 256-237-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-082088
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-082088
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: