Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | R4158 | AR |
NPI | 1053314203 |
---|---|
Provider Name | Cygnet A Bise |
First Address | Fort Smith, AR 72913-3363 |
Second Address | Fort Smith, AR 72901-4921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 11/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100174420B | (05) | OK |
149716002 | (05) | AR |
250014112 | RAIL ROAD MEDICARE (01) | AR |
4102586 | AETNA (01) | AR |
B18005 | (02) | AR |