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General NPI Number Information
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NPI Number | 1093467243
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Entity Type | Individual
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Provider Name | ALISHA SAMPLE
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 5760 CARMICHAEL PKWY
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City | MONTGOMERY
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State | AL
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Zip | 36117-2338
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Country | US
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Telephone | 334-361-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 1362 INDIAN HILLS RD
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City | PRATTVILLE
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State | AL
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Zip | 36067-7037
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 1-088225
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License Number State | AL
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