Healthcare Provider Details

I. General information

NPI: 1710712856
Provider Name (Legal Business Name): CRYSTAL NNEKA UZOIJE CRNP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

2925 CANARY ISLAND DR
MOBILE AL
36695-2595
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-2400
  • Fax:
Mailing address:
  • Phone: 251-508-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-178709
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: