Provider Demographics
NPI:1366017006
Name:CERVANTES, AL (RN)
Entity Type:Individual
Prefix:MR
First Name:AL
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18679
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8679
Mailing Address - Country:US
Mailing Address - Phone:601-705-1906
Mailing Address - Fax:601-705-1952
Practice Address - Street 1:1204 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-2823
Practice Address - Country:US
Practice Address - Phone:601-909-6832
Practice Address - Fax:601-909-6891
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse