Provider Demographics
NPI:1992892897
Name:SMITH, ALAN DAN (RN)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14871 HIGHWAY 140
Mailing Address - Street 2:
Mailing Address - City:COKER
Mailing Address - State:AL
Mailing Address - Zip Code:35452-3419
Mailing Address - Country:US
Mailing Address - Phone:205-339-1156
Mailing Address - Fax:
Practice Address - Street 1:5300 57TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-3328
Practice Address - Country:US
Practice Address - Phone:205-808-3377
Practice Address - Fax:205-808-3379
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse