Healthcare Provider Details

I. General information

NPI: 1750577581
Provider Name (Legal Business Name): LISA ANNE TOTH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#4 HIGHWAY 71 NORTHEAST
MOUNTAINBURG AR
72946
US

IV. Provider business mailing address

PO BOX 130
RATCLIFF AR
72951-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-369-2091
  • Fax: 479-369-4119
Mailing address:
  • Phone: 479-635-0091
  • Fax: 479-635-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA01247
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: