Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | A004642 | AR |
NPI | 1003274275 |
---|---|
Provider Name | Sandra Troxel |
First Address | Augusta, AR 72006-0497 |
Second Address | Jonesboro, AR 72404-9346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 17/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212121758 | (05) | AR |