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General NPI Number Information
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NPI Number | 1801103387
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Entity Type | Organization
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Legal Business Name | STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 510 CHERRY ST. NE
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City | DECATUR
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State | AL
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Zip | 35602-1628
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Country | US
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Telephone | 256-560-6507
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Fax | 256-340-9823
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Provider Business Mailing Address
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Address Line | 510 CHERRY ST. NE
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City | DECATUR
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State | AL
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Zip | 35602-1628
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Country | US
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Telephone | 256-560-6507
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Fax | 256-340-9823
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. JULIA LEE BOEHME
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Credential | CRNP
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Telephone | 256-560-6507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AL1-056716
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License Number State | AL
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