Healthcare Provider Details

I. General information

NPI: 1730865601
Provider Name (Legal Business Name): ZONNIE MAE BURNELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAMILTON PARK DR
SHERWOOD AR
72120
US

IV. Provider business mailing address

30 HAMILTON PARK DR
SHERWOOD AR
72120
US

V. Phone/Fax

Practice location:
  • Phone: 870-945-1830
  • Fax:
Mailing address:
  • Phone: 870-945-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number207170
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number207170
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number207170
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number207170
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number270170
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: