Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | A005235 | AR |
N | 363LG0600X | Nurse Practitioner - Gerontology | A005235 | AR |
NPI | 1023535952 |
---|---|
Provider Name | Jennifer Mace |
First Address | Hot Springs, AR 71913-7958 |
Second Address | Hot Springs, AR 71913-7958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 22/08/2017 |