Healthcare Provider Details

I. General information

NPI: 1831777374
Provider Name (Legal Business Name): ALEXYS NICOLE MARRUFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 6TH PL
LOWELL AR
72745-9704
US

IV. Provider business mailing address

6783 AUTUMN AVE
SPRINGDALE AR
72762-4584
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9234
  • Fax:
Mailing address:
  • Phone: 479-270-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-18213
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: