1790098770 NPI number — NORMA CAROLE WISEMAN NORDEN MD

Table of content: NORMA CAROLE WISEMAN NORDEN MD (NPI 1790098770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790098770 NPI number — NORMA CAROLE WISEMAN NORDEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORDEN
Provider First Name:
NORMA
Provider Middle Name:
CAROLE WISEMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORDEN
Provider Other First Name:
CAROLE
Provider Other Middle Name:
WISEMAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790098770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-665-8000
Provider Business Mailing Address Fax Number:
251-665-8010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 SPRING HILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-665-8000
Provider Business Practice Location Address Fax Number:
251-665-8010
Provider Enumeration Date:
07/20/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  21061 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 12834 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 12834 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)