Healthcare Provider Details

I. General information

NPI: 1043551716
Provider Name (Legal Business Name): NATALIE R BAKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 COUNTY LINE RD SUITE B
MADISON AL
35758-7719
US

IV. Provider business mailing address

12205 COUNTY LINE RD SUITE B
MADISON AL
35758-7719
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-4365
  • Fax: 256-461-0393
Mailing address:
  • Phone: 256-325-4365
  • Fax: 256-461-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number147392-21
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number0190343-23
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: