1598776726 NPI number — LORETTA PRESTON CRNP

Table of content: LORETTA PRESTON CRNP (NPI 1598776726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598776726 NPI number — LORETTA PRESTON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
LORETTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598776726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1526 5TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35233-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-279-2860
Provider Business Mailing Address Fax Number:
205-252-0197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 6TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-279-2860
Provider Business Practice Location Address Fax Number:
205-255-2019
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  1046690 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009960255 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051524381 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009960235 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051522774 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051522775 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051522770 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051522773 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009960245 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009960285 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051522768 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051524382 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891009170 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009958435 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009960275 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009973855 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051522769 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051522771 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891009160 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009960265 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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