Healthcare Provider Details

I. General information

NPI: 1962509513
Provider Name (Legal Business Name): MANDY ROSE DAVIS CRRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S 4 WEST NURSE'S DESK
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

263 PARKVIEW DR
SYLVAN SPRINGS AL
35118-9719
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9498
  • Fax: 205-939-6727
Mailing address:
  • Phone: 205-612-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number01-099110
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: