=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396872404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY ANNE SCRIBNER OTRL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 W 10TH ST
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72801-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-679-4256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 DEDICATION DR
-----------------------------------------------------
City | GREENBRIER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72058-9585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-679-4256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | OTR1636
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------