Healthcare Provider Details

I. General information

NPI: 1801001706
Provider Name (Legal Business Name): GRACE BROWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 RICE MINE ROAD N
TUSCALOOSA AL
35406
US

IV. Provider business mailing address

2868 ACTON ROAD
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-391-3099
  • Fax: 205-391-9793
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1055943
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: