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General NPI Number Information
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NPI Number | 1336417997
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Entity Type | Individual
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Provider Name | SUSAN LEA ZICKLER APN
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Gender | Female
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 103 E CRANDALL AVE
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City | HARRISON
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State | AR
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Zip | 72601-3629
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Country | US
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Telephone | 870-204-6126
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Fax | 870-204-6264
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Provider Business Mailing Address
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Address Line | 1204 SE 28TH ST SUITE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-3881
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Country | US
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Telephone | 479-464-8834
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Fax | 479-464-8838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A03627
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License Number State | AR
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