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General NPI Number Information
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NPI Number | 1467346387
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Entity Type | Individual
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Provider Name | MANDI NUSSBAUM APRN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2905 S WALTON BLVD STE 17
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City | BENTONVILLE
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State | AR
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Zip | 72712-7848
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Country | US
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Telephone | 479-269-5105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5751
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City | BELLA VISTA
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State | AR
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Zip | 72714-0751
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 232056
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License Number State | AR
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