Healthcare Provider Details

I. General information

NPI: 1093045148
Provider Name (Legal Business Name): ANNA CORI HAIRE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 EAST MOORE ST.
SEARCY AR
72143
US

IV. Provider business mailing address

1236 HIGHWAY 5
ROMANCE AR
72136
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-4181
  • Fax: 501-268-5301
Mailing address:
  • Phone: 501-230-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL49230
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: