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General NPI Number Information
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NPI Number | 1639152994
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Entity Type | Individual
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Provider Name | MARY LOU QUATTLEBAUM CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 751 PLEASANT ROW NW
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City | HUNTSVILLE
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State | AL
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Zip | 35816-2537
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Country | US
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Telephone | 256-533-6311
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Fax | 256-536-0801
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Provider Business Mailing Address
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Address Line | PO BOX 18488
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City | HUNTSVILLE
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State | AL
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Zip | 35804-8488
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Country | US
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Telephone | 256-533-6311
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Fax | 256-536-0801
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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 | 1076934
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License Number State | AL
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