Basic Information
Provider Information | |||||||||
NPI: | 1760737605 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNIVERSITY OF ALABAMA AT BIRMINGHAM | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 619 19TH ST S | ||||||||
Address2: |   | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352331900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059343411 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 619 19TH ST S | ||||||||
Address2: | BONE MARROW TRANSPLANT UNIT | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352331900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059343411 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2012 | ||||||||
LastUpdateDate: | 07/17/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SHANEYFELT | ||||||||
AuthorizedOfficialFirstName: | RACHEL | ||||||||
AuthorizedOfficialMiddleName: | ALICE | ||||||||
AuthorizedOfficialTitleorPosition: | CRNP | ||||||||
AuthorizedOfficialTelephone: | 2059343411 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | FNP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 1-106698 | AL | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.