Healthcare Provider Details

I. General information

NPI: 1497840912
Provider Name (Legal Business Name): PENNY OLIVER TOWNSEND NBC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EAST 5TH STREET
TUSCUMBIA AL
35674
US

IV. Provider business mailing address

116 EAST 5TH STREET
TUSCUMBIA AL
35674
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-9444
  • Fax: 256-381-9294
Mailing address:
  • Phone: 256-381-9444
  • Fax: 256-381-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2063
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: