Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | A004122 | AR |
NPI | 1023424413 |
---|---|
Provider Name | Mr. Samuel Raney |
First Address | Little Rock, AR 72211-4349 |
Second Address | Little Rock, AR 72211-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 07/07/2014 |