Healthcare Provider Details

I. General information

NPI: 1124692801
Provider Name (Legal Business Name): SIRENA LASHELL RABB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

PO BOX 672252
MARIETTA GA
30006-0038
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8191
  • Fax:
Mailing address:
  • Phone: 910-547-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number289396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: