Healthcare Provider Details

I. General information

NPI: 1740695683
Provider Name (Legal Business Name): MRS. MARY BRABNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax: 251-380-7995
Mailing address:
  • Phone: 251-287-8436
  • Fax: 251-380-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-025241
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: