Provider Demographics
NPI:1780970665
Name:HAAMANKULI, HIBOOMBE M (CRNP-BC)
Entity type:Individual
Prefix:MR
First Name:HIBOOMBE
Middle Name:M
Last Name:HAAMANKULI
Suffix:
Gender:M
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MITYLENE PARK LANE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-387-0948
Mailing Address - Fax:334-387-0955
Practice Address - Street 1:185 MITYLENE PARK LANE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-387-0948
Practice Address - Fax:334-387-0955
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111413363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care