Healthcare Provider Details

I. General information

NPI: 1306247317
Provider Name (Legal Business Name): REBECCA SUTTLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 02/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 7FL RM 7301F 619 19TH STREET SOUTH
BIRMINGHAM AL
35249-7404
US

IV. Provider business mailing address

176 7FL RM 7301F 619 19TH STREET SOUTH
BIRMINGHAM AL
35249-7404
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-5594
  • Fax:
Mailing address:
  • Phone: 205-975-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-127994
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-127994
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-127994
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: