Healthcare Provider Details

I. General information

NPI: 1871751800
Provider Name (Legal Business Name): LYGIS HOLCOMB CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 25TH STREET NORTH
BIRMINGHAM AL
35203
US

IV. Provider business mailing address

PO BOX 11523
BIRMINGHAM AL
35202
US

V. Phone/Fax

Practice location:
  • Phone: 205-323-5311
  • Fax: 205-439-7248
Mailing address:
  • Phone: 205-212-5600
  • Fax: 205-212-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1066041
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: