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General NPI Number Information
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NPI Number | 1639509722
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Entity Type | Individual
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Provider Name | MARCIA ROBERTS HIS
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Gender | Female
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 17 CHOCTAW TRCE
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City | CHEROKEE VILLAGE
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State | AR
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Zip | 72529-2702
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Country | US
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Telephone | 870-257-4327
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Fax | 870-257-2253
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Provider Business Mailing Address
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Address Line | 17 CHOCTAW TRCE
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City | CHEROKEE VILLAGE
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State | AR
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Zip | 72529-2702
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Country | US
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Telephone | 870-257-4327
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Fax | 870-257-2253
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 608
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License Number State | AR
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