Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | N8311 | AR |
NPI | 1235196528 |
---|---|
Provider Name | Dr. Janet Susan Cantwell |
First Address | Rogers, AR 72758-8637 |
Second Address | Rogers, AR 72758-8637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125217001 | (05) | AR |
F81150 | (02) | AR |