Healthcare Provider Details

I. General information

NPI: 1043078017
Provider Name (Legal Business Name): NOEL RUSSO CHAMBERS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1816
US

IV. Provider business mailing address

6532 OAK CREST CV
HOOVER AL
35244-6521
US

V. Phone/Fax

Practice location:
  • Phone: 205-325-8100
  • Fax:
Mailing address:
  • Phone: 850-890-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-183870
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: