Healthcare Provider Details

I. General information

NPI: 1063801280
Provider Name (Legal Business Name): CYNTHIA BATES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNORS DR SW STE 400
HUNTSVILLE AL
35801-5170
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-0116
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-7246
  • Fax: 256-265-7017
Mailing address:
  • Phone: 256-265-7246
  • Fax: 256-265-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1050236
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: