Provider Demographics
NPI:1215958210
Name:CAMP-SORRELL, LILLIAN DAWN (CRNP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DAWN
Last Name:CAMP-SORRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE, SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-6979
Mailing Address - Country:US
Mailing Address - Phone:205-939-9285
Mailing Address - Fax:205-975-1941
Practice Address - Street 1:1600 7TH AVE, SO
Practice Address - Street 2:SUITE 512
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-6979
Practice Address - Country:US
Practice Address - Phone:205-939-9285
Practice Address - Fax:205-975-1941
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-040448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891010410Medicaid
ALP00228283OtherRAILROAD MEDICARE
AL891010420Medicaid
AL51528158OtherBLUE CROSS BLUE SHIELD
AL051555888Medicaid
AL51528914OtherBLUE CROSS BLUE SHIELD
AL51555888OtherBLUE CROSS BLUE SHIELD
AL891010410Medicaid
AL051555888Medicaid