Healthcare Provider Details

I. General information

NPI: 1992065866
Provider Name (Legal Business Name): SANDRA A. DAHLBERG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA FLICK CRNP

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNORS DR SW STE 400
HUNTSVILLE AL
35801-5183
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: 256-533-7064
  • Fax: 256-704-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-094527
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: