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General NPI Number Information
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NPI Number | 1740784875
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Entity Type | Organization
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Legal Business Name | NITS END, LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 3 MCKISSIC CREEK RD
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City | BENTONVILLE
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State | AR
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Zip | 72712-8901
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Country | US
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Telephone | 479-289-8817
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Fax |
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Provider Business Mailing Address
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Address Line | 801 DALLAS ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9560
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Country | US
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Telephone | 479-787-8186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SARAH ILLAREE PATRON
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Credential |
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Telephone | 479-787-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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