BEVIN LYLE ELLENBERG CRNP NPI 1780100776

NPI Information

NPI: 1780100776
Provider Name: BEVIN LYLE ELLENBERG, CRNP
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Individual

Specialization: Primary Care

Organization: ONCOLOGY SPECIALTIES, P.C.

PECOS Registration: Yes

Address:
832 PRINCETON AVE SW
BIRMINGHAM, AL
ZIP 35211
Phone: (205) 206-8450
Get Directions

Bevin Lyle Ellenberg, CRNP is a primary care nurse practitioner in Birmingham, AL with 8 years of experience. Bevin Lyle Ellenberg, CRNP NPI is 1780100776. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

832 PRINCETON AVE SW
BIRMINGHAM, AL
ZIP 35211-320
Phone: (205) 206-8450
Fax: (205) 206-8364

The NPI 1780100776 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/21/2017 and was last updated on 3/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	1-140234	ALABAMA	No
2	363LG0600X	Nurse Practitioner	Gerontology	1-140234	ALABAMA	No
3	363LP2300X	Nurse Practitioner	Primary Care	1-140234	ALABAMA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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