Healthcare Provider Details

I. General information

NPI: 1699593129
Provider Name (Legal Business Name): EMILY SHEA-GRELLE HUTCHINSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 OSCAR BAXTER DR
TUSCALOOSA AL
35405-3698
US

IV. Provider business mailing address

3909 MCFARLAND BLVD
NORTHPORT AL
35476-2838
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-1707
  • Fax: 205-333-0782
Mailing address:
  • Phone: 205-330-1707
  • Fax: 205-333-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-162053
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: