Healthcare Provider Details

I. General information

NPI: 1841761814
Provider Name (Legal Business Name): EMILY DEFOURNEAUX CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 HUGHES RD STE 100
MADISON AL
35758-3045
US

IV. Provider business mailing address

2505 HARRISON AVE
PANAMA CITY FL
32405-4464
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone: 502-333-3768
  • Fax: 850-522-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-144863
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: