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ELIZABETH R BACCHUS NP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1578952206

Individual Registrant:
 ELIZABETH R BACCHUS NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
2256 GILMER AVE  TALLASSEE, AL 36078-7114 US
Tel: 334-567-8633  Fax: --

Contact information for business:
PO BOX 130  WETUMPKA, AL 36092-0003 US
Tel: 334-514-3821  Fax: 334-514-3686

Registration Information:
NPI: 1578952206
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
AL1-114945

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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