Healthcare Provider Details

I. General information

NPI: 1558728972
Provider Name (Legal Business Name): HEATHER EDENFIELD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

833 PRINCETON AVENUE SW POB III, SUITE 200A
BIRMINGHAM AL
35211-1303
US

V. Phone/Fax

Practice location:
  • Phone: 205-786-2776
  • Fax: 205-786-6227
Mailing address:
  • Phone: 205-786-2776
  • Fax: 205-786-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-119273
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: