Healthcare Provider Details

I. General information

NPI: 1801231857
Provider Name (Legal Business Name): BETH TAYLOR ELLIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-7310
  • Fax:
Mailing address:
  • Phone: 205-934-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1-091668
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: