Provider Demographics
NPI:1417372509
Name:SHAMA MOURTADA, HALA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HALA
Middle Name:
Last Name:SHAMA MOURTADA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:HALA
Other - Middle Name:
Other - Last Name:SHAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6213 SHANNON BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203
Mailing Address - Country:US
Mailing Address - Phone:256-371-0084
Mailing Address - Fax:
Practice Address - Street 1:6213 SHANNON BROOK LANE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203
Practice Address - Country:US
Practice Address - Phone:256-371-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123194363LF0000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse