Provider Demographics
NPI:1780151514
Name:HALBROOKS, MARY VIRGINIA
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VIRGINIA
Last Name:HALBROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KAYLEE LOOP
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-5364
Mailing Address - Country:US
Mailing Address - Phone:256-227-0876
Mailing Address - Fax:
Practice Address - Street 1:1001 HILL ST SW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2801
Practice Address - Country:US
Practice Address - Phone:256-227-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130823363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care