Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | ATP-000494 | AR |
NPI | 1174877369 |
---|---|
Provider Name | Lorie Lynn Elsea |
First Address | Springdale, AR 72762-8701 |
Second Address | Springdale, AR 72762-8701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2012 |
Last Update Date | 09/04/2013 |