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NPI Code Detail

MEDICARE: MRS. DJUANA GAIL BLACK CRNP

MEDICARE: MRS. DJUANA GAIL BLACK 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
1363LF0000XFamily Nurse Practitioner1-069323AL

General Provider Information

NPI Number : 1568777381
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DJUANA GAIL BLACK CRNP
Provider Business Mailing Address
First Line : 1050 RUBY TYLER PKWY
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35404-2958
Country : US
Telephone Number : 205-759-7246
Fax Number : 205-759-7348
Provider Business Practice Location Address
First Line : 1050 RUBY TYLER PKWY
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35404-2958
Country : US
Telephone Number : 205-759-7246
Fax Number : 205-759-7348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2010
Last Update Date : 08/17/2010

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