Healthcare Provider Details

I. General information

NPI: 1477073120
Provider Name (Legal Business Name): MICHAEL T BRASHER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR STE 410
MOBILE AL
36607-3512
US

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR STE 410
MOBILE AL
36607-3512
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-6850
  • Fax: 251-435-6859
Mailing address:
  • Phone: 251-435-6850
  • Fax: 251-450-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-129457
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: