Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 305725 | LA |
Y | 2080P0204X | Pediatric Emergency Doctor | E-11706 | AR |
NPI | 1194145599 |
---|---|
Provider Name | Alexa Bollinger |
First Address | Little Rock, AR 72202 |
Second Address | Little Rock, AR 72202-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 08/11/2018 |