Provider Demographics
NPI:1245894500
Name:WILBURN, HOLLY WORDEN (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:WORDEN
Last Name:WILBURN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3011
Mailing Address - Country:US
Mailing Address - Phone:404-688-9300
Mailing Address - Fax:
Practice Address - Street 1:1019 1ST AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3011
Practice Address - Country:US
Practice Address - Phone:404-688-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN308183363LW0102X
AL1-132942363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health