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NPI Code Detail

MEDICARE: SHALISA DUMAS BS

MEDICARE: SHALISA DUMAS BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2373H00000XDay Training/Habilitation Specialist

General Provider Information

NPI Number : 1093969990
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALISA DUMAS BS
Provider Business Mailing Address
First Line : 1500 N MISSISSIPPI ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72207-5851
Country : US
Telephone Number : 501-217-8600
Fax Number : 501-217-8636
Provider Business Practice Location Address
First Line : 1500 N MISSISSIPPI ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72207-5851
Country : US
Telephone Number : 501-217-8600
Fax Number : 501-217-8636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2008
Last Update Date : 06/26/2024

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