Healthcare Provider Details

I. General information

NPI: 1366186850
Provider Name (Legal Business Name): ELIZABETH ALTAMIRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5293
US

IV. Provider business mailing address

1000 SWN DR STE 101
CONWAY AR
72032-2558
US

V. Phone/Fax

Practice location:
  • Phone: 501-791-3331
  • Fax: 501-791-0294
Mailing address:
  • Phone: 501-328-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: