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NPI Code Detail

MEDICARE: JANICE SUDBRINK APRN

MEDICARE: JANICE SUDBRINK APRN
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
1363LF0000XFamily Nurse PractitionerA004619AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A004619OTHERARSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295192847
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE SUDBRINK APRN
Provider Business Mailing Address
First Line : 7800 DALLAS ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4278
Country : US
Telephone Number : 479-259-9286
Fax Number : 479-259-9362
Provider Business Practice Location Address
First Line : 7800 DALLAS ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4278
Country : US
Telephone Number : 479-259-9286
Fax Number : 479-259-9362
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2016
Last Update Date : 01/10/2023

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Directions to “ JANICE SUDBRINK APRN” Practice Location

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