Healthcare Provider Details

I. General information

NPI: 1881291896
Provider Name (Legal Business Name): HANNAH JANE WILBURN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W SHERMAN AVE
HARRISON AR
72601-2743
US

IV. Provider business mailing address

715 W SHERMAN AVE
HARRISON AR
72601-2743
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number213177
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: