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General NPI Number Information
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NPI Number | 1740758366
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Entity Type | Organization
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Legal Business Name | BOHANNAN ANESTHESIA PLLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 3737 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-1839
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Country | US
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Telephone | 479-246-1751
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Fax |
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Provider Business Mailing Address
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Address Line | 12688 MILLER CHURCH RD
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City | BENTONVILLE
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State | AR
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Zip | 72712-9041
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Country | US
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Telephone | 479-530-6649
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HOLLY RAE BOHANNAN
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Credential | CRNA, MSNA
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Telephone | 479-530-6649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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