Provider Demographics
NPI:1104133693
Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLINDA
Authorized Official - Middle Name:LESHUN
Authorized Official - Last Name:WORMELY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-338-3357
Mailing Address - Street 1:1175 23RD STREET NORTH
Mailing Address - Street 2:ST. CLAIR COUNTY HEALTH DEPARTMENT
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125
Mailing Address - Country:US
Mailing Address - Phone:205-338-3357
Mailing Address - Fax:205-338-4863
Practice Address - Street 1:1175 23RD STREET NORTH
Practice Address - Street 2:ST. CLAIR COUNTY HEALTH DEPARTMENT
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125
Practice Address - Country:US
Practice Address - Phone:205-338-3357
Practice Address - Fax:205-338-4863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-071785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty