1639327679 NPI number — LARA CHRISTENA ZIRBEL APN

Table of content: LARA CHRISTENA ZIRBEL APN (NPI 1639327679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639327679 NPI number — LARA CHRISTENA ZIRBEL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIRBEL
Provider First Name:
LARA
Provider Middle Name:
CHRISTENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIL
Provider Other First Name:
LARA
Provider Other Middle Name:
CHRISTENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639327679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 E MATTHEWS
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-934-1099
Provider Business Mailing Address Fax Number:
870-935-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E MATTHEWS AVE
Provider Second Line Business Practice Location Address:
SUITE #301
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-934-1099
Provider Business Practice Location Address Fax Number:
870-935-1754
Provider Enumeration Date:
09/03/2008

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: 363LF0000X , with the licence number:  A03160 ANP , 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)

  • Identifier: A03160ANP . This is a "ADVANCED PRACTICE NURSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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