Basic Information
| Provider Information | |||||||||
| NPI: | 1629470521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LITTLE ROCK NEUROSURGERY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 SAINT VINCENT CIR | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015580200 | ||||||||
| FaxNumber: | 5015580201 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 SAINT VINCENT CIR | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015580200 | ||||||||
| FaxNumber: | 5015580201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | CRAWLEY | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5015580200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A004211 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.