Healthcare Provider Details

I. General information

NPI: 1982189262
Provider Name (Legal Business Name): WALDEN BROOK SCHLUNDT-CAPPS NP-NURSE PRACTITIONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 DEARFOOT PARKWAY
TRUSSVILLE AL
35173
US

IV. Provider business mailing address

4913 DEARFOOT PARKWAY
TRUSSVILLE AL
35173
US

V. Phone/Fax

Practice location:
  • Phone: 205-873-3200
  • Fax: 205-655-5059
Mailing address:
  • Phone: 205-873-3200
  • Fax: 205-655-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-141507
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: