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NPI Code Detail

MEDICARE: MARIA L WRINKLE

MEDICARE:   MARIA L WRINKLE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1659414498
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA L WRINKLE
Provider Business Mailing Address
First Line : 417 N PEABODY STREET
Second Line : PO BOX 1660
City : MTN VIEW
State : AR
Zip : 72560
Country : US
Telephone Number : 870-269-7577
Fax Number : 501-303-3188
Provider Business Practice Location Address
First Line : 218 DOGWOOD HOLLOW RD
Second Line :
City : MOUNTAIN VIEW
State : AR
Zip : 72560-7942
Country : US
Telephone Number : 870-269-7577
Fax Number : 501-303-3188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 10/08/2008

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Directions to “ MARIA L WRINKLE ” Practice Location

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