Healthcare Provider Details

I. General information

NPI: 1083924377
Provider Name (Legal Business Name): STEPHANIE ALSBROOK R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR HEALTH MANAGEMENT
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

3333 SPRINGHILL DR HEALTH MANAGEMENT
NORTH LITTLE ROCK AR
72117-2922
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-3701
  • Fax: 501-202-3705
Mailing address:
  • Phone: 501-202-3701
  • Fax: 501-202-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1032
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: