Basic Information
| Provider Information | |||||||||
| NPI: | 1881957702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JUANITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 CENTER ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514324560 | ||||||||
| FaxNumber: | 2514329013 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 CENTER ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514324560 | ||||||||
| FaxNumber: | 2514329013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 06/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-085971 | AL | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 528600190 | 05 | AL | MEDICAID |