Provider Demographics
NPI:1801103387
Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOEHME
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-560-6507
Mailing Address - Street 1:510 CHERRY ST. NE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1628
Mailing Address - Country:US
Mailing Address - Phone:256-560-6507
Mailing Address - Fax:256-340-9823
Practice Address - Street 1:510 CHERRY ST. NE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35602-1628
Practice Address - Country:US
Practice Address - Phone:256-560-6507
Practice Address - Fax:256-340-9823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL1-056716363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty