Provider Demographics
NPI:1366006488
Name:MUKHERJEE, PURBA (CRNP)
Entity type:Individual
Prefix:
First Name:PURBA
Middle Name:
Last Name:MUKHERJEE
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 1:134 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 MEDICAL PARK EAST DR
Practice Address - Street 2:SUITE 215
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3523
Practice Address - Country:US
Practice Address - Phone:205-838-3740
Practice Address - Fax:205-423-5577
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL161126163W00000X
AL1-16126363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse