Healthcare Provider Details

I. General information

NPI: 1821237157
Provider Name (Legal Business Name): CRISCELIA AGEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 6TH AVE SOUTH
BIRMINGHAM AL
35233-1502
US

IV. Provider business mailing address

1400 6TH AVE S P.O. BOX 2648
BIRMINGHAM AL
35233-1502
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1342
  • Fax:
Mailing address:
  • Phone: 205-930-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1-066159
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: