Healthcare Provider Details

I. General information

NPI: 1699133025
Provider Name (Legal Business Name): MARY AUSTIN WOLF HALL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

PO BOX 12366
BIRMINGHAM AL
35202-2366
US

V. Phone/Fax

Practice location:
  • Phone: 205-206-8475
  • Fax: 205-206-8395
Mailing address:
  • Phone: 205-780-7101
  • Fax: 205-206-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-136378
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-136378
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-136378
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: