Healthcare Provider Details

I. General information

NPI: 1619914090
Provider Name (Legal Business Name): MALINDA DRUSCILLA BAUCUM C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 3RD AVE S KB 321
BIRMINGHAM AL
35294-0002
US

IV. Provider business mailing address

2531 MOUNTAIN BROOK CIR
BIRMINGHAM AL
35223-1107
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-4951
  • Fax: 205-996-5358
Mailing address:
  • Phone: 205-540-1523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-098736
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: