Healthcare Provider Details

I. General information

NPI: 1093754947
Provider Name (Legal Business Name): THERESA M. WADAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRINCETON AVE SW SUITE 707
BIRMINGHAM AL
35211
US

IV. Provider business mailing address

2450 BROOKLINE DR
HOOVER AL
35226-1402
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-9309
  • Fax:
Mailing address:
  • Phone: 205-824-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1037839
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: