Healthcare Provider Details

I. General information

NPI: 1558791269
Provider Name (Legal Business Name): NANCY RECHTFERTIG REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 LATHAM DR
LOWELL AR
72745-8360
US

IV. Provider business mailing address

530 COURTNEY LN
ROGERS AR
72756-9337
US

V. Phone/Fax

Practice location:
  • Phone: 476-750-0130
  • Fax: 479-750-0937
Mailing address:
  • Phone: 479-544-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number163WP0200X
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: