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General NPI Number Information
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NPI Number | 1326549429
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Entity Type | Individual
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Provider Name | MARY VIRGINIA COLVERT CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 200 RIVERHILL BUSINESS PARK #250
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City | BIRMINGHAM
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State | AL
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Zip | 35242
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Country | US
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Telephone | 205-995-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 703 BROADWAY ST
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City | HOMEWOOD
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State | AL
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Zip | 35209-6209
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Country | US
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Telephone | 256-345-4238
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-144851
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-144851
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-144851
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License Number State | AL
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