Healthcare Provider Details

I. General information

NPI: 1255720348
Provider Name (Legal Business Name): ANGELA RENE' PONTIUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZRB 239 1720 2ND AVENUE SOUTH
BIRMINGHAM AL
35294-0007
US

IV. Provider business mailing address

1931 9TH AVE S 155 COMMUNITY CARE BUILDING
BIRMINGHAM AL
35294-0007
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-2780
  • Fax: 205-975-7764
Mailing address:
  • Phone: 205-996-2780
  • Fax: 205-975-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-087382
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: