Healthcare Provider Details

I. General information

NPI: 1861949521
Provider Name (Legal Business Name): ANGELA SBANOTTO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

IV. Provider business mailing address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-5150
  • Fax:
Mailing address:
  • Phone: 479-986-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL053226
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: