Healthcare Provider Details

I. General information

NPI: 1851563407
Provider Name (Legal Business Name): BRAGAN D PETREY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S CPP 230
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9107
  • Fax: 205-939-9821
Mailing address:
  • Phone: 205-939-9107
  • Fax: 205-996-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-096846
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: