Basic Information
Provider Information
NPI: 1164718631
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOX
FirstName: NATALIE
MiddleName: SUZANNE
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 40480
Address2:  
City: MOBILE
State: AL
PostalCode: 366400480
CountryCode: US
TelephoneNumber: 2514105437
FaxNumber: 2514343802
Practice Location
Address1: 1601 CENTER ST
Address2: STE 1N
City: MOBILE
State: AL
PostalCode: 366041512
CountryCode: US
TelephoneNumber: 2514105437
FaxNumber: 2514343802
Other Information
ProviderEnumerationDate: 06/23/2011
LastUpdateDate: 03/29/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X1-113168ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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