Healthcare Provider Details

I. General information

NPI: 1427799600
Provider Name (Legal Business Name): MARY TALBOT SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 20TH AVE S #2
BIRMINGHAM AL
35223
US

IV. Provider business mailing address

2322 20TH AVE S #2
BIRMINGHAM AL
35223
US

V. Phone/Fax

Practice location:
  • Phone: 912-401-4685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-182421
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: