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THERESA DARLENE PUTMAN CRNP
>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1609114198
Individual Registrant: THERESA DARLENE PUTMAN CRNP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
108 4TH AVE SW STE A REFORM, AL 35481-8018 US
Tel: 205-375-6251 Fax: --
Tel: 205-375-6251 Fax: --
Contact information for business:
108 4TH AVE SW STE A REFORM, AL 35481-8018 US
Tel: 205-375-6251 Fax: --
Tel: 205-375-6251 Fax: --
Registration Information:
NPI: 1609114198
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | AL | 1-074182 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
