Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | R3542 | AR |
Y | 208600000X | Surgeon | R3542 | AR |
NPI | 1013952365 |
---|---|
Provider Name | Connie L Hiers |
First Address | Jonesboro, AR 72401-6007 |
Second Address | Jonesboro, AR 72401-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B90302 | (02) |