Healthcare Provider Details

I. General information

NPI: 1548681430
Provider Name (Legal Business Name): ALICE HANNIFIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2569 DOUGLASS AVE
MEMPHIS TN
38114-2532
US

IV. Provider business mailing address

2595 CENTRAL AVE
MEMPHIS TN
38104-5905
US

V. Phone/Fax

Practice location:
  • Phone: 901-701-2550
  • Fax:
Mailing address:
  • Phone: 901-260-8500
  • Fax: 901-260-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17991
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: