Healthcare Provider Details

I. General information

NPI: 1144698580
Provider Name (Legal Business Name): MANDI E BOHLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 HIGDON FERRY RD STE 200
HOT SPRINGS AR
71913-6981
US

IV. Provider business mailing address

157 TRABECCA CIR
HOT SPRINGS AR
71913-8165
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-2781
  • Fax:
Mailing address:
  • Phone: 501-520-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004484
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: