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General NPI Number Information
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NPI Number | 1295840452
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Entity Type | Organization
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Legal Business Name | WOMENS WELLNESS CENTER OF NORTHEAST ARKANSAS, LTD.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 800 S CHURCH ST SUITE 100
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City | JONESBORO
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State | AR
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Zip | 72401-4176
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Country | US
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Telephone | 870-932-8181
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Fax | 870-932-8193
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Provider Business Mailing Address
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Address Line | PO BOX 1636
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City | JONESBORO
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State | AR
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Zip | 72403-1636
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Country | US
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Telephone | 870-932-8181
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Fax | 870-932-8193
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROLYN S TODDY
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Credential |
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Telephone | 870-932-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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