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General NPI Number Information
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NPI Number | 1770673246
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Entity Type | Individual
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Provider Name | MARY A. TRENTHAM APN
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 138 BRIGHTON TER
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City | HOT SPRINGS
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State | AR
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Zip | 71913-7144
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Country | US
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Telephone | 501-786-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 106 SECLUDED CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72210-1718
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Country | US
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Telephone | 501-786-8696
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | A01494
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License Number State | AR
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