Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E- 9261 | AR |
NPI | 1003255985 |
---|---|
Provider Name | Dr. Rachael Nambusi |
First Address | Fayetteville, AR 72703-1908 |
Second Address | Fayetteville, AR 72703-1908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 14/07/2015 |