Healthcare Provider Details

I. General information

NPI: 1699165258
Provider Name (Legal Business Name): GRACE ZILLS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S JACKSON HWY SUITE 300
SHEFFIELD AL
35660-5777
US

IV. Provider business mailing address

1120 S JACKSON HWY SUITE 300
SHEFFIELD AL
35660-5777
US

V. Phone/Fax

Practice location:
  • Phone: 256-383-4447
  • Fax: 256-381-7999
Mailing address:
  • Phone: 256-383-4447
  • Fax: 256-381-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-131486
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: