Healthcare Provider Details

I. General information

NPI: 1265666010
Provider Name (Legal Business Name): NANCY MARCHBANK CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21698 HAYNES RD
HENSLEY AR
72065-9103
US

IV. Provider business mailing address

21698 HAYNES RD
HENSLEY AR
72065-9103
US

V. Phone/Fax

Practice location:
  • Phone: 501-626-3767
  • Fax:
Mailing address:
  • Phone: 501-626-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number050093020905E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: