Healthcare Provider Details

I. General information

NPI: 1306440425
Provider Name (Legal Business Name): ANNALIN ELISE WREN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 INDEPENDENCE DR STE 200
HOMEWOOD AL
35209-4164
US

IV. Provider business mailing address

3485 INDEPENDENCE DR
HOMEWOOD AL
35209-5603
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-0920
  • Fax: 205-445-0115
Mailing address:
  • Phone: 205-930-0920
  • Fax: 205-445-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-169045
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-169045
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: