Healthcare Provider Details

I. General information

NPI: 1891173639
Provider Name (Legal Business Name): MRS. ANNETTE REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

2850 ESAU AVE
MOBILE AL
36617-1656
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax:
Mailing address:
  • Phone: 251-457-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number2-032599
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: