Healthcare Provider Details

I. General information

NPI: 1275732570
Provider Name (Legal Business Name): ANISSA ROCHELLE THOMAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRINCETON AVE SW SUITE 201, POB 1
BIRMINGHAM AL
35211-1310
US

IV. Provider business mailing address

1821 ENFIELD ST
BIRMINGHAM AL
35217-2610
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-7705
  • Fax: 205-783-7706
Mailing address:
  • Phone: 205-849-4105
  • Fax: 205-841-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-072173
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: