Healthcare Provider Details

I. General information

NPI: 1568190759
Provider Name (Legal Business Name): BETH LALAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 D'OLIVE 201 D'OLIVE ST
BAY MINETTE AL
36507
US

IV. Provider business mailing address

PO BOX 2048
MOBILE AL
36652-2048
US

V. Phone/Fax

Practice location:
  • Phone: 251-706-8700
  • Fax: 251-937-6169
Mailing address:
  • Phone: 251-436-7646
  • Fax: 251-436-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9420228
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9420228
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: