Healthcare Provider Details

I. General information

NPI: 1154788453
Provider Name (Legal Business Name): ANNA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVENUE SOUTH
BIRMINGHAM AL
35294
US

IV. Provider business mailing address

2829 CROSS BRIDGE DR
VESTAVIA AL
35216-7103
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-127560
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: