Healthcare Provider Details

I. General information

NPI: 1730199571
Provider Name (Legal Business Name): EVA FAYE ANKROM-GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SPRINGHILL AVENUE
MOBILE AL
36604
US

IV. Provider business mailing address

1361 ROTTERDAM CT
MOBILE AL
36605-2021
US

V. Phone/Fax

Practice location:
  • Phone: 251-219-3916
  • Fax: 251-219-3952
Mailing address:
  • Phone: 251-219-3916
  • Fax: 251-219-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: