=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659951465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY HARTENBOWER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2021
-----------------------------------------------------
Last Update Date | 04/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 W PLEASANT GROVE RD STE 101
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-326-8525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16989 WHITE OAK RIDGE RD
-----------------------------------------------------
City | PEA RIDGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72751-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-447-0103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 215124
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------