Healthcare Provider Details

I. General information

NPI: 1265707889
Provider Name (Legal Business Name): MARY A CRONIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 CAHABA RIVER RD STE 101-D
BIRMINGHAM AL
35243-2344
US

IV. Provider business mailing address

1021 SNOWSHILL CIR
BIRMINGHAM AL
35242-5649
US

V. Phone/Fax

Practice location:
  • Phone: 205-739-2266
  • Fax: 205-739-2335
Mailing address:
  • Phone: 205-266-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1119324
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1-119324
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: