Healthcare Provider Details

I. General information

NPI: 1194717827
Provider Name (Legal Business Name): MARIE-ALEXIS SIMIERITSCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15341 HIGHWAY 278
DOUBLE SPRINGS AL
35553-2407
US

IV. Provider business mailing address

15341 HIGHWAY 278
DOUBLE SPRINGS AL
35553-2407
US

V. Phone/Fax

Practice location:
  • Phone: 205-489-3322
  • Fax: 205-489-3325
Mailing address:
  • Phone: 205-489-3322
  • Fax: 205-489-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1075181
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: