Provider Demographics
NPI:1851571467
Name:BACKEL, ROBERTA JO (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JO
Last Name:BACKEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 MADISON BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2002
Mailing Address - Country:US
Mailing Address - Phone:256-464-9991
Mailing Address - Fax:256-464-9994
Practice Address - Street 1:8216 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2002
Practice Address - Country:US
Practice Address - Phone:256-464-9991
Practice Address - Fax:256-464-9994
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily