Healthcare Provider Details

I. General information

NPI: 1588608699
Provider Name (Legal Business Name): LAURIE HARLAN ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE AVE SUITE 401
SPRINGDALE AR
72764-5335
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-2989
  • Fax: 479-757-2989
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC8262
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: