Healthcare Provider Details

I. General information

NPI: 1255757209
Provider Name (Legal Business Name): LAURA ROMUNDSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 GRANDVIEW PARKWAY SUITE 100
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

3670 GRANDVIEW PARKWAY SUITE 100
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1800
  • Fax: 205-971-1801
Mailing address:
  • Phone: 205-971-1800
  • Fax: 205-971-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-126813
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-126813
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-126813
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: