Healthcare Provider Details

I. General information

NPI: 1790690964
Provider Name (Legal Business Name): BLANCA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GREGORY DR
GREEN FOREST AR
72638-3541
US

IV. Provider business mailing address

605 GREGORY DR
GREEN FOREST AR
72638-3541
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-5242
  • Fax: 870-438-6343
Mailing address:
  • Phone: 870-438-5242
  • Fax: 870-438-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberL057460
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: