Healthcare Provider Details

I. General information

NPI: 1093062275
Provider Name (Legal Business Name): AIMEE SUSANNE MCGILL CNA, RMA, MH, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W NONNAMAKER DR
FAYETTEVILLE AR
72701-7140
US

IV. Provider business mailing address

304 W NONNAMAKER DR
FAYETTEVILLE AR
72701-7140
US

V. Phone/Fax

Practice location:
  • Phone: 479-502-2491
  • Fax:
Mailing address:
  • Phone: 479-502-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number114234568
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number050377550911E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: