Healthcare Provider Details

I. General information

NPI: 1437726395
Provider Name (Legal Business Name): ENRG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 LOOP RD STE 4
ORANGE BEACH AL
36561-6213
US

IV. Provider business mailing address

620 N MCKENZIE ST STE 200
FOLEY AL
36535-3520
US

V. Phone/Fax

Practice location:
  • Phone: 251-240-0842
  • Fax:
Mailing address:
  • Phone: 251-943-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WATSON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 251-943-9355