Healthcare Provider Details

I. General information

NPI: 1801662374
Provider Name (Legal Business Name): LATYA ONJALEK MCCALL NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 OLD SHELL RD
MOBILE AL
36607-2505
US

IV. Provider business mailing address

5873 SPYGLASS DR
MOBILE AL
36618-2602
US

V. Phone/Fax

Practice location:
  • Phone: 251-301-6521
  • Fax:
Mailing address:
  • Phone: 251-508-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1-174336
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: