Healthcare Provider Details

I. General information

NPI: 1861827669
Provider Name (Legal Business Name): LILIAN IFEOMA AKWUBA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MITYLENE PARK LN
MONTGOMERY AL
36117-3758
US

IV. Provider business mailing address

128 MITYLENE PARK LN
MONTGOMERY AL
36117-3758
US

V. Phone/Fax

Practice location:
  • Phone: 334-239-7020
  • Fax: 334-239-7062
Mailing address:
  • Phone: 334-538-2769
  • Fax: 334-239-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-103472
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: