=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730191255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VETERANS ADMINISTRATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 N COLLEGE AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-1944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-443-4301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4847 W WEDINGTON DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-5856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-443-4301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF ANESTHESIST
-----------------------------------------------------
Name | JANIE LINDA SHERWOOD
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 479-443-4301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 282NOOOOOX
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------