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NPI Code Detail

MEDICARE: MS. MARY ANN CARTHAN RN

MEDICARE: MS. MARY ANN CARTHAN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseL41077AR
2163W00000XRegistered NurseR090690AR

General Provider Information

NPI Number : 1174599443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ANN CARTHAN RN
Provider Business Mailing Address
First Line : PO BOX 1589
Second Line :
City : BENTON
State : AR
Zip : 72018-1589
Country : US
Telephone Number : 501-315-3344
Fax Number : 501-620-5109
Provider Business Practice Location Address
First Line : 1628 E PAGE AVE
Second Line :
City : MALVERN
State : AR
Zip : 72104-4524
Country : US
Telephone Number : 501-315-3344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 09/26/2018

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