Healthcare Provider Details

I. General information

NPI: 1720270986
Provider Name (Legal Business Name): MAIJA SHIRLEY R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

IV. Provider business mailing address

2212 JONATHAN LN
SEARCY AR
72143-5048
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1291
  • Fax: 870-262-1365
Mailing address:
  • Phone: 501-305-4752
  • Fax: 870-262-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number999
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: