Healthcare Provider Details

I. General information

NPI: 1598006314
Provider Name (Legal Business Name): DEE ESTABROOK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 HIGHWAY 321 N
AUSTIN AR
72007
US

IV. Provider business mailing address

751 HIGHWAY 321 N
AUSTIN AR
72007-9088
US

V. Phone/Fax

Practice location:
  • Phone: 501-650-2920
  • Fax:
Mailing address:
  • Phone: 501-650-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL35710
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: