Healthcare Provider Details

I. General information

NPI: 1508117649
Provider Name (Legal Business Name): BRANDY LEE LUNSFORD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-3600
  • Fax: 251-410-3700
Mailing address:
  • Phone: 251-410-3600
  • Fax: 251-410-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-105856
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: