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General NPI Number Information
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NPI Number | 1578304044
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Entity Type | Organization
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Legal Business Name | ADVANCED ILLNESS MANAGEMENT
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 446 ROBINHOOD LN
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City | HARDY
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State | AR
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Zip | 72542-9032
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Country | US
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Telephone | 815-262-6518
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Fax |
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Provider Business Mailing Address
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Address Line | 6834 CANTRELL RD # 1437
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4135
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Country | US
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Telephone | 815-262-6518
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE DAWN CRAWFORD
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Credential | APRN
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Telephone | 815-262-6518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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