Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | A01543 | AZ |
NPI | 1013021724 |
---|---|
Provider Name | Angela Francine Dougan |
First Address | Scott, AR 72142 |
Second Address | North Little Rock, AR 72114-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 29/03/2012 |