Provider Demographics
NPI:1962448423
Name:MCANALLEY, MARILYN D (CRNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:D
Last Name:MCANALLEY
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 1:1001 S JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5760
Mailing Address - Country:US
Mailing Address - Phone:256-386-7774
Mailing Address - Fax:256-386-7780
Practice Address - Street 1:1001 S JACKSON HWY
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5760
Practice Address - Country:US
Practice Address - Phone:256-386-7774
Practice Address - Fax:256-386-7780
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-055027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051536566Medicare PIN
P40983Medicare UPIN