Healthcare Provider Details

I. General information

NPI: 1962653782
Provider Name (Legal Business Name): ANGELA SEALS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 SUMMITT
JASPER AL
35501-0102
US

IV. Provider business mailing address

1280 SUMMIT DRIVE
JASPER AL
35501-0102
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-7555
  • Fax: 205-384-9006
Mailing address:
  • Phone: 205-387-7555
  • Fax: 205-384-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-084804
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: