Healthcare Provider Details

I. General information

NPI: 1144055237
Provider Name (Legal Business Name): HALLIE RUANE THUENEN CRNP PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5729 COVE COMMONS DR SE STE C
BROWNSBORO AL
35741-3501
US

IV. Provider business mailing address

5729 COVE COMMONS DR SE STE C
BROWNSBORO AL
35741-3501
US

V. Phone/Fax

Practice location:
  • Phone: 256-367-2686
  • Fax: 256-292-0114
Mailing address:
  • Phone: 256-367-2686
  • Fax: 256-292-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-179601
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: