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General NPI Number Information
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NPI Number | 1528597028
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Entity Type | Individual
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Provider Name | Cabun Rural Health Services, Inc.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 601 Dr. MLK BLVD Suite A
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City | El Dorado
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State | AR
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Zip | 71730
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Country | US
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Telephone | 8706393875
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Fax |
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Provider Business Mailing Address
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Address Line | 1329 Orchard Lane
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City | El Dorado
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State | AR
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Zip | 71730
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Country | US
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Telephone | 8703140134
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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 | A005126
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License Number State | AR
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