Healthcare Provider Details

I. General information

NPI: 1912512435
Provider Name (Legal Business Name): LASHANDRA WALTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-2992
  • Fax: 205-316-7675
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-150667
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: