Healthcare Provider Details

I. General information

NPI: 1598760365
Provider Name (Legal Business Name): MICHAEL LITT LEMLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4316
US

IV. Provider business mailing address

725 DIANE LN
CONWAY AR
72034-9362
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2093
  • Fax:
Mailing address:
  • Phone: 501-513-1185
  • Fax: 501-513-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC00583
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: