Healthcare Provider Details

I. General information

NPI: 1245266881
Provider Name (Legal Business Name): SUSAN P TOMPKINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 S FOREST AVE
LUVERNE AL
36049-7306
US

IV. Provider business mailing address

1704 S FOREST AVE
LUVERNE AL
36049-7306
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-3383
  • Fax: 334-335-3078
Mailing address:
  • Phone: 334-335-3383
  • Fax: 334-335-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-057277
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: