Healthcare Provider Details

I. General information

NPI: 1407193584
Provider Name (Legal Business Name): DIANNE PHILLIPS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S LOWDER BLDG SUITE 318
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S LOWDER BLDG SUITE 318
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9840
  • Fax: 205-975-6024
Mailing address:
  • Phone: 205-638-9840
  • Fax: 205-975-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-051802
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-051802
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: