Healthcare Provider Details

I. General information

NPI: 1811057060
Provider Name (Legal Business Name): MARY LOU ZIROLI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH STREET SOUTH
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

PO BOX 55309
BIRMINGHAM AL
35255-5309
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number822
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: