Healthcare Provider Details

I. General information

NPI: 1053738732
Provider Name (Legal Business Name): ALICE SPRINGER BRISTOW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28921 HIGHWAY 5
WOODSTOCK AL
35188-3613
US

IV. Provider business mailing address

7980 BEAU RIDGE LN
MC CALLA AL
35111-4134
US

V. Phone/Fax

Practice location:
  • Phone: 205-938-9348
  • Fax:
Mailing address:
  • Phone: 205-477-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-108892
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: