Healthcare Provider Details

I. General information

NPI: 1619251568
Provider Name (Legal Business Name): MARY LUCY MATTEI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LUCY WEST CRNP

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SPRING HILL AVE
MOBILE AL
36604-1405
US

IV. Provider business mailing address

PO BOX 40430
MOBILE AL
36640-0430
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8000
  • Fax: 251-665-8010
Mailing address:
  • Phone: 251-665-8000
  • Fax: 251-665-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-110564
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: