Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | E-11751 | AR |
NPI | 1235505074 |
---|---|
Provider Name | Dr. Rebecca Cisneros |
First Address | Alexander, AR 72002-1889 |
Second Address | Fort Smith, AR 72903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 13/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235505074 | (05) | AR |