Provider Demographics
NPI:1336891506
Name:NACHTIGAL, EVETTE MADRID
Entity type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:MADRID
Last Name:NACHTIGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4007
Mailing Address - Country:US
Mailing Address - Phone:256-686-9195
Mailing Address - Fax:256-304-5381
Practice Address - Street 1:3309 BOB WALLACE AVE SW STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4007
Practice Address - Country:US
Practice Address - Phone:256-686-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health