1215958210 NPI number — LILLIAN DAWN CAMP-SORRELL CRNP

Table of content: LILLIAN DAWN CAMP-SORRELL CRNP (NPI 1215958210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215958210 NPI number — LILLIAN DAWN CAMP-SORRELL CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMP-SORRELL
Provider First Name:
LILLIAN
Provider Middle Name:
DAWN
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:
1215958210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 7TH AVE, SOUTH
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:
35233-6979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-939-9285
Provider Business Mailing Address Fax Number:
205-975-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE, SO
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-6979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-9285
Provider Business Practice Location Address Fax Number:
205-975-1941
Provider Enumeration Date:
07/22/2006

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: 363LF0000X , with the licence number:  1-040448 , 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: 891010410 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00228283 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891010420 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51528158 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051555888 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51528914 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51555888 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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