Healthcare Provider Details

I. General information

NPI: 1154341774
Provider Name (Legal Business Name): HOLLIS LEE WARD CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

251 N BAYOU ST
MOBILE AL
36603-5827
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax: 251-544-2188
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-544-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1071723
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR881863
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: