Brandy    Laurenzi    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1609178714
Tax ID
844784659
Effective Date
7/7/2022
Last Updated
7/15/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
277 Huntress Street
Wetumpka, AL 36092
United States
Phone
334-274-9000 (Phone)
Billing Details
Address
277 Huntress Street
Wetumpka, AL 36092
Billing Phone
334-274-9000
Specialty Type
Nurse Practitioner
Map
Address