1225546161 NPI number — NATALIE MILLS KRODELL NURSE PRACTITIONER

Table of content: NATALIE MILLS KRODELL NURSE PRACTITIONER (NPI 1225546161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225546161 NPI number — NATALIE MILLS KRODELL NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRODELL
Provider First Name:
NATALIE
Provider Middle Name:
MILLS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225546161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2012 S PROMENADE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72758-9073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-616-1485
Provider Business Mailing Address Fax Number:
479-239-0536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 S PROMENADE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-616-1485
Provider Business Practice Location Address Fax Number:
479-239-0536
Provider Enumeration Date:
01/12/2018

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: 363L00000X , with the licence number:  A005404 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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