Healthcare Provider Details

I. General information

NPI: 1619961646
Provider Name (Legal Business Name): MARILOU SHREVE DNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 52ND ST 200
ROGERS AR
72758-8637
US

IV. Provider business mailing address

507 NW C ST
BENTONVILLE AR
72712-4747
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-1100
  • Fax:
Mailing address:
  • Phone: 479-422-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA01589
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: