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General NPI Number Information
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NPI Number | 1366637498
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Entity Type | Individual
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Provider Name | LAJARLYN ROSE WESLEY RN
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Gender | Female
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 501 E MAIN ST
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City | GURDON
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State | AR
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Zip | 71743-1243
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Country | US
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Telephone | 870-353-4329
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Fax |
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Provider Business Mailing Address
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Address Line | 67 BLUE MOUNTAIN DR
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City | MAUMELLE
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State | AR
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Zip | 72113-6399
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Country | US
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Telephone | 501-269-5813
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Fax |
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | R78563
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License Number State | AR
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