Provider Demographics
NPI:1942517420
Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-281-6091
Mailing Address - Street 1:20 TECHNOLOGY CT.
Mailing Address - Street 2:MARTHA C. MYERS F/P CLINIC
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-3200
Mailing Address - Country:US
Mailing Address - Phone:334-281-6091
Mailing Address - Fax:334-284-5291
Practice Address - Street 1:20 TECHNOLOGY CT.
Practice Address - Street 2:MARTHA C. MYERS F/P CLINIC
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3200
Practice Address - Country:US
Practice Address - Phone:334-281-6091
Practice Address - Fax:334-284-5291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty