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General NPI Number Information
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NPI Number | 1750918660
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Entity Type | Individual
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Provider Name | LRAE URAINUZ WINTERCORN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 201 S 19TH ST STE A
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City | ROGERS
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State | AR
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Zip | 72758-1123
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Country | US
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Telephone | 479-372-3700
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Fax | 479-207-9643
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Provider Business Mailing Address
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Address Line | 201 S 19TH ST STE A
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City | ROGERS
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State | AR
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Zip | 72758-1123
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Country | US
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Telephone | 479-372-3700
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Fax | 479-207-9643
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 124349
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License Number State | AR
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