Healthcare Provider Details

I. General information

NPI: 1750547204
Provider Name (Legal Business Name): BRANDY LYNN RHODES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8832 US HWY 90
DAPHNE AL
36526
US

IV. Provider business mailing address

70 MIDTOWN PARK EAST
MOBILE AL
36606-4140
US

V. Phone/Fax

Practice location:
  • Phone: 251-289-1786
  • Fax:
Mailing address:
  • Phone: 251-289-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-144507
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: