Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 213270 | AR |
NPI | 1154882793 |
---|---|
Provider Name | Ms. Carmen Lynne Weddle |
First Address | Carlisle, AR 72024 |
Second Address | Little Rock, AR 72205-6321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 11/11/2020 |