Healthcare Provider Details

I. General information

NPI: 1821482944
Provider Name (Legal Business Name): DEBBIE VAIL NC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13536 COUNTY ROAD 45
TUSKEGEE AL
36083-6117
US

IV. Provider business mailing address

13536 COUNTY ROAD 45
TUSKEGEE AL
36083-6117
US

V. Phone/Fax

Practice location:
  • Phone: 334-750-3276
  • Fax:
Mailing address:
  • Phone: 334-750-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberR008584499
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: