MEDICARE: MRS. AFRICA OLYMPIA TODD 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	163WG0000X	General Practice Registered Nurse	1-099436	AL

General Provider Information

NPI Number	:	1497214134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AFRICA OLYMPIA TODD CRNP

Provider Business Mailing Address
First Line	:	PO BOX 1045
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36868-1045
Country	:	US
Telephone Number	:	334-291-5255
Fax Number	:	877-395-0710

Provider Business Practice Location Address
First Line	:	1810 STADIUM DR STE 210
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3179
Country	:	US
Telephone Number	:	334-291-5255
Fax Number	:	877-395-0710

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

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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