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General NPI Number Information
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NPI Number | 1801503297
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Entity Type | Organization
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Legal Business Name | CLIO HEALTH CLINIC LLC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 1203 BLUE SPRINGS ST
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City | CLIO
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State | AL
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Zip | 36017-2523
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Country | US
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Telephone | 334-490-1200
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Fax | 334-780-1070
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Provider Business Mailing Address
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Address Line | 1203 BLUE SPRINGS ST
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City | CLIO
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State | AL
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Zip | 36017-2523
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Country | US
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Telephone | 334-490-1200
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Fax | 334-780-1070
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Authorized Official
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Title or Position | CEO
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Name | URSULA S WILSON
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Credential | LNP
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Telephone | 334-490-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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