Healthcare Provider Details

I. General information

NPI: 1598765208
Provider Name (Legal Business Name): ARLENE URMAZA NEPOMUCENO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E APPLEBY RD STE 101
FAYETTEVILLE AR
72703-3928
US

IV. Provider business mailing address

12 E APPLEBY RD STE 101
FAYETTEVILLE AR
72703-3928
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-4444
  • Fax:
Mailing address:
  • Phone: 479-463-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberE-4939
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: