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General NPI Number Information
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NPI Number | 1518581248
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Entity Type | Organization
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Legal Business Name | DIVINE FAMILY WELLNESS, LLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 400 BEXAR AVE W
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City | HAMILTON
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State | AL
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Zip | 35570-5522
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Country | US
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Telephone | 205-921-2838
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Fax | 205-430-2672
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Provider Business Mailing Address
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Address Line | PO BOX 522
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City | HAMILTON
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State | AL
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Zip | 35570-0522
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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 | OWNER
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Name | ASHLEY N OZBIRN
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Credential | CRNP
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Telephone | 205-921-2838
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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 |
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License Number State |
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