Provider Demographics
NPI:1205861440
Name:COLE, MARY ELLEN (MSN,CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:COLE
Suffix:
Gender:F
Credentials:MSN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TOWNCENTER BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1833
Mailing Address - Country:US
Mailing Address - Phone:205-750-0030
Mailing Address - Fax:205-750-0855
Practice Address - Street 1:100 TOWNCENTER BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1833
Practice Address - Country:US
Practice Address - Phone:205-750-0030
Practice Address - Fax:205-750-0855
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1030536363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051592254OtherBLUE CROSS BLUE SHIELD