Healthcare Provider Details

I. General information

NPI: 1356641732
Provider Name (Legal Business Name): SABRINA R MACKSOUD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD SUITE 202
MONTGOMERY AL
36116
US

IV. Provider business mailing address

2105 E SOUTH BLVD SUITE 412
MONTGOMERY AL
36116-2409
US

V. Phone/Fax

Practice location:
  • Phone: 334-538-6608
  • Fax: 334-286-2684
Mailing address:
  • Phone: 334-538-6608
  • Fax: 334-386-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-092389
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: