Healthcare Provider Details

I. General information

NPI: 1376561761
Provider Name (Legal Business Name): MARK C HAMELINK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MORROW ST N
MENA AR
71953-2516
US

IV. Provider business mailing address

728 HWY 375 E
MENA AR
71953
US

V. Phone/Fax

Practice location:
  • Phone: 479-243-0971
  • Fax: 843-664-3723
Mailing address:
  • Phone: 479-216-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN1492
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: