Basic Information
| Provider Information | |||||||||
| NPI: | 1144698580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOHLEN | ||||||||
| FirstName: | MANDI | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 TRABECCA CIR | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719138165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015204862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1662 HIGDON FERRY RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016232781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A004484 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 210404758 | 05 | AR | MEDICAID |