Provider Demographics
NPI:1487753315
Name:MOSTELLA, HEATHER LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:MOSTELLA
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 1:460 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3838
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-997-5995
Practice Address - Street 1:460 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3838
Practice Address - Country:US
Practice Address - Phone:256-891-0300
Practice Address - Fax:256-891-7461
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRN 1-0874451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556700Medicaid
AL51556700Medicare ID - Type Unspecified
ALQ40470Medicare UPIN