Healthcare Provider Details

I. General information

NPI: 1932299393
Provider Name (Legal Business Name): VALLAREE GAIL PRENTICE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 B HWY 72 E
GURLEY AL
35748-0127
US

IV. Provider business mailing address

PO BOX 127 5995 B HWY 72 E
GURLEY AL
35748-0127
US

V. Phone/Fax

Practice location:
  • Phone: 256-776-2094
  • Fax: 256-776-0047
Mailing address:
  • Phone: 256-776-2094
  • Fax: 256-776-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-051281
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: