MEDICARE: LRAE URAINUZ WINTERCORN FNP-BC

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	363L00000X	Nurse Practitioner	124349	AR

General Provider Information

NPI Number	:	1750918660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LRAE URAINUZ WINTERCORN FNP-BC

Provider Business Mailing Address
First Line	:	201 S 19TH ST STE A
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1123
Country	:	US
Telephone Number	:	479-372-3700
Fax Number	:	479-207-9643

Provider Business Practice Location Address
First Line	:	201 S 19TH ST STE A
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1123
Country	:	US
Telephone Number	:	479-372-3700
Fax Number	:	479-207-9643

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

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	06/09/2022

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