Provider Demographics
NPI:1396589420
Name:BACKSTROM, MARGARET ELAINE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELAINE
Last Name:BACKSTROM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELAINE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3090 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-6109
Mailing Address - Country:US
Mailing Address - Phone:706-518-5441
Mailing Address - Fax:
Practice Address - Street 1:702 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-2834
Practice Address - Country:US
Practice Address - Phone:334-644-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263766363LF0000X
AL3-001849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily