MEDICARE: MRS. ERIN SANDEFUR APRN

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
1	363LF0000X	Family Nurse Practitioner	A004295	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5BA31	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1184015422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN SANDEFUR APRN

Provider Business Mailing Address
First Line	:	1301 WHITE DR
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-9467
Country	:	US
Telephone Number	:	870-307-8326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 WHITE DR
Second Line	:
City	:	BATESVILLE
State	:	AR
Zip	:	72501-9467
Country	:	US
Telephone Number	:	870-793-5504
Fax Number	:	870-262-3253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	05/27/2016

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