Provider Demographics
NPI:1104226471
Name:UNIV OF AR FOR MEDICAL SCIENCES
Entity type:Organization
Organization Name:UNIV OF AR FOR MEDICAL SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPNP/ADVANCED PRACTICE NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:COOKUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-515-8877
Mailing Address - Street 1:1301 WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 WOLFE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5320
Practice Address - Country:US
Practice Address - Phone:501-364-2660
Practice Address - Fax:501-364-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004159261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center