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General NPI Number Information
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NPI Number | 1457415713
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Entity Type | Individual
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Provider Name | SUSAN MARIE CHEATWOOD II NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2018 BROOKWOOD MEDICAL CTR DR
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6898
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Country | US
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Telephone | 205-877-2667
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Fax |
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Provider Business Mailing Address
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Address Line | 1371 HIGHWAY 468
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City | VINCENT
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State | AL
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Zip | 35178-6413
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Country | US
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Telephone | 205-672-8712
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-042571
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License Number State | AL
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