Healthcare Provider Details

I. General information

NPI: 1821042300
Provider Name (Legal Business Name): DANA LYNNE BURCHFIELD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/23/2024
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NW A ST WASHINGTON REGIONAL DIAGNOSTIC CLINIC
BENTONVILLE AR
72712-3985
US

IV. Provider business mailing address

12 E APPLEBY RD CLINIC ADMINISTRATION
FAYETTEVILLE AR
72703-3901
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-3050
  • Fax: 479-273-0050
Mailing address:
  • Phone: 479-463-1704
  • Fax: 479-463-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA001803
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: