Healthcare Provider Details

I. General information

NPI: 1699304733
Provider Name (Legal Business Name): NATALIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE NEWMAN

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 02/01/2024
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

5564 PARK SIDE CIR
HOOVER AL
35244-5123
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3411
  • Fax:
Mailing address:
  • Phone: 901-871-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-173800
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-173800
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: