Healthcare Provider Details

I. General information

NPI: 1447752126
Provider Name (Legal Business Name): CYNTHIA MONCRIEF GILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 CENTER ST STE A
MOBILE AL
36604-1512
US

IV. Provider business mailing address

1610 CENTER ST STE A
MOBILE AL
36604-1512
US

V. Phone/Fax

Practice location:
  • Phone: 251-432-7879
  • Fax: 251-432-9013
Mailing address:
  • Phone: 251-432-7879
  • Fax: 251-432-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-063901
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: