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General NPI Number Information
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NPI Number | 1528541455
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Entity Type | Individual
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Provider Name | CHASTIDY LARSON ROBB NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 5 MOBILE INFIRMARY CIR
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City | MOBILE
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State | AL
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Zip | 36607-3513
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Country | US
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Telephone | 251-435-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 5266 FLETCHING CT
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City | THEODORE
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State | AL
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Zip | 36582-7356
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Country | US
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Telephone | 251-455-1811
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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 | 1-141773
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License Number State | AL
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