MEDICARE: HEATHER LOUISE PRECISE CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	1-070104	AL

General Provider Information

NPI Number	:	1073618963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LOUISE PRECISE CRNP

Provider Business Mailing Address
First Line	:	840 MONTCLAIR RD
Second Line	:	SUITE 617
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-591-2393
Fax Number	:	205-595-5099

Provider Business Practice Location Address
First Line	:	840 MONTCLAIR RD
Second Line	:	SUITE 617
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-591-2393
Fax Number	:	205-595-5099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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