Healthcare Provider Details

I. General information

NPI: 1841699535
Provider Name (Legal Business Name): NANNETTE MCDANIEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

IV. Provider business mailing address

1830 COUNTY ROAD 107
PRATTVILLE AL
36066-6747
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8057
  • Fax: 334-293-6756
Mailing address:
  • Phone: 334-391-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-094561
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-094561
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-094561
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: