Healthcare Provider Details

I. General information

NPI: 1265201230
Provider Name (Legal Business Name): MRS. SAVANNAH MAENSIVU ROSAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SE PLAZA AVE STE 5
BENTONVILLE AR
72712-5473
US

IV. Provider business mailing address

901 SE PLAZA AVE STE 5
BENTONVILLE AR
72712-5473
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-3376
  • Fax: 479-273-3468
Mailing address:
  • Phone: 479-273-3376
  • Fax: 479-273-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226826
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: