Healthcare Provider Details

I. General information

NPI: 1467878223
Provider Name (Legal Business Name): MANDY BROOKS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S LOWDER 316
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S LOWDER 316
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number1-112811
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: